JTCVS Open (Apr 2025)

Surveying surgeon practices and perspectives on extent of intraoperative nodal evaluation in non–small cell lung cancerCentral MessagePerspective

  • Lyndon C. Walsh, BA,
  • Alessandro Brunelli, MD,
  • Biniam Kidane, MD, MSc,
  • Jazmin Eckhaus, MBBS,
  • Pierre Olivier Fiset, MD, PhD,
  • Jonathan D. Spicer, MD, PhD,
  • Mara B. Antonoff, MD

Journal volume & issue
Vol. 24
pp. 376 – 382

Abstract

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Objective: The National Comprehensive Cancer Network and Commission on Cancer guidelines encourage surgeons to obtain tissue from 1 or more N1 and 3 N2 nodal stations during resection for non–small cell lung cancer. We aimed to characterize surgeons’ familiarity with and adherence to recommended guidelines and to elucidate factors influencing surgical practices globally. Methods: A questionnaire was designed to assess surgeon behaviors regarding intraoperative nodal assessment decisions during lung cancer resection. Survey items included demographics, case-based scenarios, self-perceived behaviors regarding nodal decision-making, and knowledge-based questions regarding nodal assessment guidelines. The survey was distributed to the General Thoracic Surgical Club, European Society of Thoracic Surgeons, Canadian Association of Thoracic Surgeons, and Australian & New Zealand Society of Cardiac & Thoracic Surgeons. Results: Altogether, 236 of 2396 surgeons (9.8%) from 46 countries responded. The majority were men (192/236) and general thoracic surgeons (204/236). Participants were subcategorized into North America (n = 96), Europe (n = 96), and All Other (n = 44). The importance of 4 variables that impact lymph node excision varied by region: length of procedure (P = .04), patient age (P = .0004), patient frailty (P = .0034), and institutional guidelines (P = .01). Surgeons stated that in patients who received neoadjuvant treatment, most would opt for a full lymphadenectomy. A total of 80.5% (n = 190) claimed familiarity with guidelines, yet only 56.4% (n = 133) could identify the guidelines. Conclusions: The variables driving intraoperative decision-making for nodal dissection vary by region. Moreover, surgeons tend to overstate their knowledge of existing guidelines. To optimize cancer care around the world, education needs to be provided uniformly to drive positive patient outcomes.

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