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Breakthrough research to be presented at the 2026 Society of Thoracic Surgeons (STS) Annual Meeting suggests that more comprehensive lymph node assessment during surgery is critical to accurately staging and treating patients with clinically node-negative non-small cell lung cancer (NSCLC). Christopher Seder, MD, thoracic surgeon and professor of surgical sciences at Rush University Medical Center, will present the J. Maxwell Chamberlain Memorial Paper in General Thoracic Surgery, Association Between Nodal Assessment, Upstaging, and Survival in Resected Clinically Node-negative Non-small Cell Lung Cancer, on Saturday, Jan. 31, at 7:35 a.m. during the “Research in Focus: Distinguished Abstracts” session.

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Although imaging may indicate that NSCLC has not spread to lymph nodes, global surgical standards vary widely regarding how many nodes should be removed and evaluated. In North America, guidelines introduced in 2021 recommend assessment of one N1 node in the hilar or root of the lung and three N2 nodes in the mediastinum. Using data from the STS General Thoracic Surgery Database, researchers found that this approach may miss disease spread, as cancer was more frequently identified in N1 nodes than in N2 nodes, with many metastatic nodes located adjacent to the bronchi. The study recommends removal and evaluation of more than one N1 node in addition to at least three N2 nodes.

The analysis examined a large, multi-center cohort of clinically node-negative NSCLC patients treated over a three-year period. Patients underwent wedge resection, segmentectomy, or lobectomy, and a meaningful proportion were upstaged after surgery when lymph node dissection revealed more advanced disease than initially diagnosed. Patients who received neoadjuvant therapy, underwent preoperative mediastinoscopy, lacked PET-CT imaging, or had incomplete pathology data were excluded. Expanded nodal assessment improved detection of occult disease, enabling more accurate staging and more appropriate use of chemotherapy and additional treatments.  

“We are narrowing down the best techniques for lymph node dissections in patients with lung cancer to give the best chance of identifying any cancer that is there and improving survival,” says Dr. Seder. “The onus here is not only on surgeons to dissect out more lymph nodes, but on pathologists to take this lung specimen we give them and do a very thorough evaluation of that lung specimen to get all the additional lymph nodes with cancer that are hiding in the specimen.”
 

During the Saturday, Jan. 31, 7:50 a.m. presentation of the James S. Tweddell Memorial Paper for Congenital Heart Surgery, Elaine Griffeth, MD, of Mayo Clinic, will present new research as part of the “Research in Focus: Distinguished Abstracts” session at the 2026 Society of Thoracic Surgeons (STS) Annual Meeting. Her talk, Extended Validation of an Institutional Machine Learning Model for Postoperative Morbidity and Mortality Risk in Adult Congenital Heart Disease Patients Undergoing Cardiac Reoperation, will explore how advanced risk modeling can better inform surgical decision-making for adults with congenital heart disease (CHD).

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Adults with CHD represent a growing and medically complex population. Most were born with structural heart defects and underwent surgery early in life, yet many require additional cardiac operations as adults. Prior surgeries, evolving anatomy, and long-term health challenges make it difficult to accurately estimate operative risk using existing tools designed for the broader adult cardiac surgery population, highlighting the need for a CHD-specific national risk assessment model.

The study analyzed cases from the STS Adult Cardiac Surgery Database spanning several years, building on prior Mayo Clinic work using machine learning and logistic regression. Seven factors were strongly associated with postoperative morbidity and mortality: sex, age, single-ventricle physiology, surgical urgency, kidney function, ejection fraction, and prior heart operations.  

“This is a work in progress,” says Dr. Griffeth. “We want to have high reliability in the surgeries we are offering, and we are trying to tailor this model with data from past patients. The more informed patients are about their risks for surgery, the better.”