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subjects who are being consented to this study and undergoing lymph node dissection as outlined in this protocol

A lobectomy specimen's resection will undergo systematic lymph node dissection either by the patient's treating thoracic surgeon and/or by a member of the pathology team.

The protocol for a standardized lymph node dissection consists of a series of blunt peribronchial dissections starting from the hilum to the periphery, with particular attention to points of airway bifurcation where intrapulmonary lymph nodes aggregate. By emphasizing the intrapulmonary lymph node map and a standardized dissection, the team will remove more lymph nodes from the lobectomy specimen, resulting in an accurate N staging.

Subjects undergoing a lung specimen lymph node dissection

Control group

Paula Ugalde Figueroa, M.D.

Lung cancer patients undergoing upfront surgery, highly benefit from a systematic lymph node dissection in the mediastinum and in the surgical specimens. The latter is performed by the pathologist. Developing a standardized technique to dissect the lobectomy specimen has the potential of maximizing the retrieval of all N1 stations lymph nodes. The investigators believe that the adoption of such technique will improve lung cancer staging and identify a higher number of patients that qualify for adjuvant therapies.

Anatomic lung resection with systematic mediastinal lymph node dissection is the standard of care for patients with clinical stage I or II non-small cell lung cancer (NSCLC). While the best type of resection may sometimes be debated, it is clear that mediastinal, hilar, and lobar lymph nodes (LNs) should be routinely retrieved to achieve a complete lung cancer resection. According to major international guidelines, at least 3 hilar/intrapulmonary stations and 3 mediastinal stations should be assessed during resection. Although there is still a debate over whether the ideal number of LN stations sampled or the total number of LNs removed per station provides a better analysis, radical systematic LN dissection seems to offer the best oncological outcomes. In fact, in patients with tumors ≤4 cm in diameter completely resected, the quality of the mediastinal lymph node dissection and the thoroughness of the examination of the surgical specimen will select candidates for adjuvant treatment and define oncologic prognosis. The consequences of an incorrect lymph node classification can be substantial: while patients with N0 NSCLC have approximately 75% 5-year overall survival (OS), patients with NSCLC classified as N1 have a 5-year OS of 49%, and patients with NSCLC classified as N2 a 5-year OS of 36%. Therefore, the burden of determining the correct prognosis lies on the surgeon to perform a rigorous and thorough oncological resection, and on the pathologist to fully assess enough intrapulmonary LNs. Inaccuracy by either specialist leads to pathologic understage and suboptimal clinical management, which will lead to poor patient outcomes.

Developing a standardized technique to dissect the lobectomy specimen has the potential of maximizing the retrieval of all N1 stations lymph nodes. The investigators believe that the adoption of such technique will improve lung cancer staging and identify a higher number of patients that qualify for adjuvant therapies.

Maximizing Lymph Node Dissection on Fresh and Fixed Lung Cancer Resection Specimens

To compare the number of stations and lymph nodes sampled when adopting a standardized technique compared to the conventional (prior) technique.

Determine the number of cases upstaged to N1 with the intrapulmonary lymph node dissection compared to the conventional technique.

Three years recurrence-free survival rate of patients undergoing standardize dissection versus conventional technique.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Maximizing Lymph Node Dissection on Fresh and Fixed Lung Cancer Resection Specimens	NCT06252129	Lung Cancer Lymph Node Meta... Pathologic Proc...	Subjects underg... Control group	18 Years -	Brigham and Women's Hospital
Maximizing Lymph Node Dissection on Fresh and Fixed Lung Cancer Resection Specimens	NCT06252129	Lung Cancer Lymph Node Meta... Pathologic Proc...	Subjects underg... Control group	18 Years -	Brigham and Women's Hospital

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