2023 World Conference on Lung Cancer (Posters)-P1.25. Adequacy of Mediastinal Lymph Node Dissection in the Setting of New NCCN Guidelines: Simplified Method From A Rural Hospital

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This study examines the implementation of a simplified method for mediastinal lymph node dissection in non-small cell lung cancer patients in accordance with updated guidelines from the National Comprehensive Cancer Network (NCCN). The previous guidelines recommended sampling at least ten lymph nodes from any location, while the revised guidelines suggest sampling from at least three N2 stations and one N1 station. The study aims to improve compliance with the new guidelines without the additional cost of commercial lymph node sampling kits.<br /><br />The researchers conducted a retrospective cohort review of Video Assisted Thoracoscopic Surgeries (VATS) performed at a rural hospital between May 2019 and February 2023. Starting in April 2021, they implemented a non-commercial tool and a "triple-check" collection method to ensure proper lymph node sampling. The tool included a laminated printout listing specific lymph node stations for right and left sided lung resections, which was displayed in the operating room for easy reference. The surgeon would call out the station as the nodes were handed off to the surgical technician, who placed them in the appropriate labeled containers. The circulating nurse would then check off the nodal station on the tool using a dry erase marker. Before concluding the case, the surgeon would confirm with the surgical technician, the circulating nurse, and the tool to ensure all stations were addressed.<br /><br />The primary outcome of the study was the mean number of lymph node stations dissected for each patient before and after implementing the lymph node sampling tool and "triple-check" system. The secondary outcome was the mean number of lymph nodes sampled for each patient. The study reviewed a total of 136 cases, 67 before implementation of the method and 69 after.<br /><br />The results showed a statistically significant increase in the mean number of lymph node stations dissected and the mean total number of lymph nodes sampled after implementing the method. In conclusion, the study suggests that the use of a simple, non-commercial tool and the "triple-check" system can improve compliance with NCCN guidelines for lymph node sampling without the added cost of commercial kits. The researchers believe that this system fosters shared responsibility among the surgical team and can lead to appropriate upstaging and escalation of therapy, ultimately improving prognosis. Further research with a larger sample size is needed to confirm the impact on upstaging.

Asset Subtitle

Kevin Kennedy

Meta Tag

Speaker Kevin Kennedy

Topic Early-Stage NSCLC: Changing Paradigms & Outcomes

Keywords

mediastinal lymph node dissection

non-small cell lung cancer

updated guidelines

National Comprehensive Cancer Network

lymph node sampling

Video Assisted Thoracoscopic Surgeries

rural hospital

triple-check system

lymph node stations

surgical team