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Eur J Cardiothorac Surg 2006;30:787-792
© 2006 Elsevier Science NL

Invited paper

ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer

^a Department of Thoracic Surgery, University Hospital, Zurich, Switzerland
^b Department of Thoracic Surgery, University Hospital, Leuven, Belgium
^c Department of Thoracic and Vascular Surgery, University Hospital, Antwerp, Belgium
^d Division of Thoracic Surgery Hospital, Mutua de Terrassa, Spain
^e Department of Thoracic Surgery, University Hospitals Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
^f Department of Thoracic Surgery, University Hospital, Freiburg, Germany
^g Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
^h Department of Pathology, University Hospital, Bochum, Germany
ⁱ Division of Thoracic Surgery, University Hospital La Sapienza, Roma, Italy
^j Division of Thoracic and Vascular Surgery, University Hospital, Lausanne, Switzerland
^k Department of Thoracic Surgery, University Hospital, Freiburg, Germany
^l Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, USA

Received 15 September 2005; received in revised form 5 July 2006; accepted 14 August 2006.

^_* Corresponding author. Tel.: +41 1 2558802; fax: +41 1 2558805. (Email: walter.weder{at}usz.ch).

The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. The objective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and the pathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on the subjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus. Systematic nodal dissection is recommended in all cases to ensure complete resection. Lobe-specific systematic nodal dissection is acceptable for peripheral squamous T1 tumors, if hilar and interlobar nodes are negative on frozen section studies; it implies removal of, at least, three hilar and interlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies and sampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resected separately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does not detect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolated tumor cells in hematoxylin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patients with these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging and pathologic evaluation, and improve pathologic staging, which will help decide on the best adjuvant therapy.

Key Words: Lung cancer • Intraoperative lymph node staging • Pathologic evaluation of lymph nodes

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