Evaluation of Uncertain Resection for Localized Non-small Cell Lung Cancer: The Crucial Prognosis of Suboptimal Lymph Node Assessment

• DOI: 10.1016/j.athoracsur.2025.02.004
• Publication Date: 2025-02-28T00:05:17Z
• Authors: Romain Vergé; Axel Rouch; Pierre Rabinel; Claire Renaud; Mathilde Cazaux; Laurent Brouchet

Surgery is the cornerstone of treatment for early-stage non-small cell lung cancer (NSCLC). The concept "uncertain resection" (R(un)) describes cases where complete tumor excision with clear margins achieved but without comprehensive lymph node assessment or pleural cytology. This study aimed to establish R(un) as a prognostic factor in localized NSCLC patients and explore its heterogeneity. single-center retrospective was conducted at Toulouse University Hospital. Consecutive who underwent surgery between 2008 2018 were included. Resection status, particularly R(un), reclassified retrospectively. Overall survival disease-free analyzed, Cox proportional hazards regression model used assess whether newly proposed subcategories independent predictors survival. Among 1,108 patients, 732 (66.1%) classified R0, 291 (26.2%) 85 (7.7%) R1. Our demonstrated that an factor, adjusted hazard ratios 1.26[95% CI: 1.03-1.52] overall 1.23[95% 1.03-1.46] A classification system three revealed continuum uncertain incomplete resections (p<0.001). validated updated resection highlighted significant impact suboptimal assessment. These results underscore heterogeneity among need precise improve outcomes.