75P - Adequacy of lymph node sampling during surgical resection of lung cancer at a regional UK thoracic surgical centre 2011-2013

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Non-Small-Cell Lung Cancer, Early Stage
Surgery and/or Radiotherapy of Cancer
Presenter Matthew Evison
Citation Annals of Oncology (2015) 26 (suppl_1): 18-23. 10.1093/annonc/mdv048
Authors M. Evison, S. Britton, H. Al-Najjar, P. Crosbie, M. Jones, P. Bishop, P. Krysiak, K. Rammohan, R. Shah, R. Booton
  • North West Lung Centre, Wythenshawe Hospital-South Manchester University Hospitals Trust, M23 9LT - Manchester/UK

Abstract

Aim/Background

Adequate lymph node sampling during surgical resection of lung cancer is pivotal part of the management pathway. It informs prognosis, treatment (identifying patients that may benefit from adjuvant chemotherapy) and surveillance programs following treatment. The University Hospital of South Manchester (UHSM) is a large regional Lung Cancer and Thoracic Surgical Centre. This study aimed to analyse the adequacy of lymph node sampling during lung cancer resections at this centre.

Methods

A retrospective study of all pathological reports for patients undergoing lung cancer resections from 01/01/2011 to 31/12/2013. Resection specimens are reported according to Royal College of Pathology Dataset requirements for lung cancer. All resection types were included (pneumonectomy, bilobectomy, lobectomy, segmentectomy, wedge resection). Lymph node sampling was considered adequate if the following criteria were fulfilled, based on the International Association for the Study of Lung cancer Staging Manual in Thoracic Oncology: At least 3 mediastinal lymph node stations, Station 7 sampled in all cases, Station 5/6 in cases of a left upper lobe tumour and Station 9 in cases of a lower lobe tumour.

Results

A total of 986 patients underwent lung cancer resections in the study period. 16 were excluded with incomplete data. The number of resections per year increased significantly during the study period; 2001–174, 2012–333, 2013–464. The adequacy of lymph node sampling stratified by calendar year is presented in table 1.

2011 n = 173 2012 n = 333 2013 n = 464
Overall proportion of adequate nodal sampling 13% 23/173 22% 73/333 38% 174/464
Station 7 sampled 36% 63/173 46% 154/333 63% 290/464
Station 5/6 in LUL tumours 72% 42/58 73% 72/98 76% 104/137
Station 9 in lower lobe tumours 49% 37/75 52% 66/128 60% 124/208

Conclusions

The adequacy of lymph sampling is improving year on year in all fields of adequacy. There is no national recording of sampling adequacy to compare our centre to. Sampling of station 7 in all cases is a focus area where significant improvements in overall adequacy rate can be made. Ongoing annual analysis is required to monitor and drive ongoing improvements; something we believe should be undertaken at a national level.

Disclosure

All authors have declared no conflicts of interest.