General Thoracic

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.”
 

Lung cancer causes more deaths in the United States each year than breast, colon, and prostate cancers combined. Yet, despite strong evidence showing that annual screening with low-dose CT (LDCT) scans significantly reduces lung cancer mortality among high-risk individuals^[1],^[2], fewer than 18.2% of eligible patients currently undergo screening.

Simultaneously published in The Annals of Thoracic Surgery, The Journal of the American College of Radiology, and The International Journal of Radiation Oncology, Biology, Physics and jointly issued by The Society of Thoracic Surgeons (STS), The American College of Radiology (ACR), and The American Society for Radiation Oncology (ASTRO), the article examines recurring methodological flaws in the literature that may limit knowledge of, and access to, lung cancer screening (LCS).

The editorial originated from the STS Lung Cancer Screening Task Force and was led by its chair, Elliot Servais, MD, Department of Surgery at Lahey Hospital & Medical Center.

“In this paper, we address these misconceptions head-on with the goal of expanding access to screening and saving more lives from lung cancer,” said Dr. Servais. “Lung cancer screening saves lives. Multiple high-quality studies have clearly demonstrated its benefit. Despite this strong evidence, persistent misinformation about perceived harms continues to limit the uptake of this life-saving test.”

The authors note that methodological shortcomings in published research—including overestimation of downstream complications, misrepresentation of false-positive rates, and flawed analyses of CT-related radiation risk—may deter patients and clinicians from lung cancer screening, highlighting the need for accurate, evidence-based communication of its benefits and risks.

The full joint editorial is now available online:

[1] DOI: 10.1056/NEJMoa1911793 
[2] DOI: 10.1056/NEJMoa1102873