Recommendation-adherent systematic lymph node sampling is not associated with increased complication rates in non-small cell lung cancer surgery - combined cardiothoracic center experience

Sep 22, 2026

Lymph node harvesting during lung resection is central to lung cancer treatment, yet the safe and required extent remains debated. Some approaches favor limited sampling to reduce complications linked to more extensive nodal dissection. This study evaluates postoperative complication rates across different lymph node sampling strategies in non-small cell lung cancer patients undergoing lobectomy at a combined cardiothoracic unit.

LanguageEnglish

CategoryResearch & Report

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Pages7

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Introduction

Materials and methods

Brief Report Recommendation-adherent systematic lymph node sampling isnot associated with increased complication rates in non-small cell lung cancer surgery—combined cardiothoracic center experience Aapo Pikkujämsä1,2,3^, Tuomas Mäkelä1,3^, Joonas H. Kauppila1,4^, Olli Helminen1^, Fredrik Yannopoulos1,3^ 1Research Unit of Translational Medicine, Medical Research Center, University of Oulu, Oulu, Finland; 2Department of Surgery, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland; 3Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland; 4Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden Correspondence to: Aapo Pikkujämsä, MD. Research Unit of Translational Medicine, Medical Research Center, University of Oulu, Oulu, Finland; Department of Surgery, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland; Department of Cardiothoracic Surgery, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, [Finland. Email: aapo.pikkujamsa@student.oulu.fi](Finland. Email: aapo.pikkujamsa@student.oulu.fi). Abstract: Lymph node harvesting during lung resection procedures is a crucial part of treating lung cancer. Despite medical consensus on this issue, the required and safe extent of lymph node harvesting is under debate. A competing, more conservative approach to nodal harvesting suggests that some patients may benefit from limited sampling (LS), thus avoiding complications related to more extensive nodal dissection. Our goal was to evaluate the complication rates with different lymph node sampling strategies. A retrospective single-center cohort study conducted at a combined cardiothoracic unit (n=521) was formed of patients with non-small cell lung cancer (NSCLC) that underwent lobectomy. Patients were divided into three groups based on the extent of mediastinal nodal sampling: no sampling (NS, n=89), LS (n=313) and recommendation-adherent systematic sampling (RA, n=119) . Comparison was made between the three groups. The primary outcome was any postoperative complication. Complication rate was similar between the groups, overall complication 38.2% for NS, 39.6% for LS and 35.3% for RA, P=0.30 . Comprehensive complication index (CCI) median 0, interquartile range (IQR) 0–20.9 in all groups, P=0.89 . The number of severe complications did not differ at a statistically significant level between the groups, NS 12.4%, LS 11.2% vs. RA 17.6%, P=0.20 . Main conclusion was that more extensive lymph node harvesting was not associated with increased complication rates in NSCLC patients who underwent lobectomy. Keywords: Lung cancer; lymph node sampling; complication rate; thoracic surgery; cardiothoracic surgery Submitted Jan 21, 2026. Accepted for publication Mar 19, 2026. Published online Apr 14, 2026. doi: 10.21037/jtd-2026-1-0209 View this article at: [https://dx.doi.org/10.21037/jtd-2026-1-0209](https://dx.doi.org/10.21037/jtd-2026-1-0209) Introduction Lung cancer is the leading cause of cancer mortality worldwide (1). Surgery for lung cancer includes harvesting of lymph nodes to establish accurate cancer staging and can be carried out to variable extents ranging from more limited or selective lymph node sampling to full lymph node dissection with all adjacent mediastinal fatty tissue removed (2) . During lung cancer surgery lymph nodes can be resected from several stations, specifically stations 2–11 (3) . Limited sampling (LS) includes harvesting lymph nodes only from stations of immediate proximity to the tumor or only including lymph nodes that are in the lobe, whereas systematic lymph nodal sampling aims to collect a specific ^ ORCID: Aapo Pikkujämsä, 0009-0006-3408-729X; Tuomas Mäkelä, 0009-0002-3254-7011; Joonas H. Kauppila, 0000-0001-6740-3726; Olli Helminen, 0000-0001-9544-6475; Fredrik Yannopoulos, 0000-0003-3009-8558. © AME Publishing Company. J Thorac Dis 2026;18(4):409 | [https://dx.doi.org/

FAQs

What was the study’s primary goal?

To determine whether more extensive lymph node harvesting is safe by evaluating perioperative complication rates across sampling strategies.

How were patients grouped based on lymph node sampling extent?

Patients undergoing lobectomy were divided into no sampling (NS), limited sampling (LS), and recommendation-adherent systematic sampling (RA) groups.

What conclusion did the study reach about complication rates?

More extensive lymph node harvesting was not associated with increased complication rates in NSCLC patients undergoing lobectomy.

Sep 22, 2026

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