Lymph node assessment and survival: we still have work to do
Thoracic surgeons generally agree that surgical resection of non-small cell lung cancer (NSCLC) should include hilar and mediastinal lymph node assessment. A quality measure of 10 or more lymph nodes have been established by the national quality forum as a target number of nodes for resection, based on work that suggested it was important for accurate staging. Adequate nodal assessment is especially important given the beneficial role for adjuvant chemotherapy in patients with nodal metastases. However, despite the consensus opinion that nodal assessment is paramount, studies have demonstrated wide variability in the number of nodes sampled (1,2) The recent paper by David and colleagues (3) confirms this variability and attempts to categorize the effects of lymph node sampling on overall and cancer-specific survival using the California Cancer Registry.