Journal of Surgical Oncology最新文献

{"title":"Neoadjuvant Immune Therapy in Patients With Melanoma: Response and Toxicity in a Non-Clinical Trial Setting","authors":"Orna T. Cantillon,&nbsp;Klaus J. Busam,&nbsp;Charlotte E. Ariyan,&nbsp;Edmund K. Bartlett,&nbsp;Danielle M. Bello,&nbsp;Michael A. Postow,&nbsp;Mary S. Brady","doi":"10.1002/jso.70324","DOIUrl":"10.1002/jso.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Neoadjuvant therapy with immune checkpoint inhibitors (ICIs) is increasingly used in advanced or recurrent melanoma based on outcomes observed in clinical trials. The efficacy and toxicity of this in a real-world setting remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>We conducted a retrospective review of adults with cutaneous melanoma who received neoadjuvant ICI as first line therapy at our institution between 2019 and 2024. Patients had advanced melanoma that was surgically resectable and treated with neoadjuvant intent. The primary outcome was pathological response, with a secondary outcome of immune-related toxicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 81 patients were identified. The median age was 64 (range: 21–86). There were 48 males. Most patients received 2 cycles (<i>n</i> = 53) prior to resection (range: 1–7 cycles). Dual ICI was the most common approach (<i>n</i> = 62). Disease stage ranged from IIC to IV, with 57% IIIC. Half were pathologic non-responders (<i>n</i> = 41). Pathologic complete response (pCR) was seen in 25% (<i>n</i> = 20), near-pCR in 2% (<i>n</i> = 2) and partial PR in 10% (<i>n</i> = 8). Ten (12%) patients had a discrepant PR between two or more resected sites. Immune related adverse events were observed in 34 (42%) patients; 21 (26%) grade 1–2, and 13 (16%) grade 3–4. Overall survival trended towards significance (<i>p</i> = 0.07) for those with mPR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Non-trial use of neoadjuvant ICI therapy is associated with a less favourable pathological response than reported in clinical trials and similar risks of toxicity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"574-583"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Prophylactic and Contralateral Risk-Reducing Mastectomy in Women With Germline CDH1 Pathogenic or Likely-Pathogenic Variants","authors":"Giovanni Corso,&nbsp;Carlo La Vecchia,&nbsp;Francesca Magnoni,&nbsp;Andrea Polizzi,&nbsp;Elisa Bottazzoli,&nbsp;Alessandra De Scalzi,&nbsp;Susanna Di Silvestre,&nbsp;Eleonora Meduri,&nbsp;Filippo Pesapane,&nbsp;Luca Nicosia,&nbsp;Francesca De Lorenzi,&nbsp;Mattia Intra,&nbsp;Viviana Galimberti,&nbsp;Paolo Veronesi","doi":"10.1002/jso.70323","DOIUrl":"10.1002/jso.70323","url":null,"abstract":"<p>Bilateral prophylactic mastectomy (BPM) or contralateral risk-reducing mastectomy (CRRM) are considered in <i>CDH1</i> carriers as a strategy to reduce lobular breast cancer (LBC) risk in women. In this study we aimed to evaluate the overall number of these procedures reported in literature. We conducted a literature search and a scoping review through the PUBMED database. We identified eleven studies eligible for our interest. Overall numbers, frequencies, geographic distribution, family history, and post-operative histopathological findings of BPM or CRRM were the main outcomes considered. Articles reporting information about BPM or CRRM were reported only in Europe and North America. A total of 75 (32.1%) women were treated with any mastectomy (BPM or CRRM), from a population of 234 positive at <i>CDH1</i> genetic testing; 81.3% of these women, were treated in North America and 18.7% in Europe. In total, 69.3% of surgical procedures were BPM and 30.7% were CRRM; 76.9% of BPMs were performed in North America, and 23.1% in Europe. Instead, 91.3% of CRRMs were reported in North America, and 8.7% in Europe, respectively. A positive family history for BC was documented in 81.8% and post-operative histopathological findings described at least one in situ LBC in nearly all breast specimens. In conclusion, BPM or CRRM were performed in about 1/3 of women with germline <i>CDH1</i> pathogenic or likely pathogenic variants; studies were reported only in Western countries. Family history for BC in <i>CDH1</i> carriers and detection of LCIS in post-operative specimens were also frequently described</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"475-480"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Evidence for Circulating Tumor DNA in Sarcoma: Challenges and Opportunities for Clinical Application","authors":"Kristin E. Goodsell,&nbsp;Jason A. Carter,&nbsp;Hannah R. Abrams,&nbsp;Harveshp Mogal,&nbsp;Elizabeth T. Loggers,&nbsp;Jeremy Sharib","doi":"10.1002/jso.70326","DOIUrl":"10.1002/jso.70326","url":null,"abstract":"<p>Sarcomas represent a diverse group of mesenchymal tumors with high rates of recurrence after resection. While recent technical advances have enabled the detection of rare circulating tumor DNA (ctDNA) in other malignancies, the complexity and heterogeneity of sarcoma genomics have historically limited ctDNA in these cancers. This narrative review highlights the rapidly evolving evidence supporting potential clinical applications of ctDNA in common sarcoma subtypes including gastrointestinal stromal tumor, leiomyosarcoma, rhabdomyosarcoma, osteosarcoma, and Ewing sarcoma.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"490-501"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended Curettage for Local Control of Chondromyxoid Fibroma: A 33-Year Experience at a Single Tertiary Center.","authors":"Liuzhe Zhang, David Clever, Aaron M Gazendam, Anthony M Griffin, Kim Tsoi, Peter C Ferguson, Jay S Wunder","doi":"10.1002/jso.70385","DOIUrl":"https://doi.org/10.1002/jso.70385","url":null,"abstract":"<p><strong>Background and objectives: </strong>The management of chondromyxoid fibroma (CMF) primarily relies on surgical resection, but simple curettage is reportedly associated with a high local recurrence rate. While extended curettage with high-speed burring effectively manages other locally aggressive bone tumors, its effectiveness for CMF remains unclear. We aimed to evaluate the outcome of this technique for CMF.</p><p><strong>Methods: </strong>We retrospectively reviewed 31 CMF patients treated at a single tertiary academic hospital between 1990 and 2023. Demographics and treatment details were collected. The primary outcome was local recurrence-free survival for the patients who underwent extended curettage and had follow-up for more than 6 months. The secondary outcome was complications.</p><p><strong>Results: </strong>The median age was 41 (IQR, 18-47), and 61% were male. Of the total 31 patients, 26 underwent extended curettage with high-speed burring, while five underwent en bloc resection. No local recurrence occurred in either group. Among the extended curettage group, 21 had a follow-up of more than 6 months (median follow-up: 37 months [IQR, 18-58 months]), only one complication (symptomatic hardware removal) was recorded.</p><p><strong>Conclusions: </strong>Extended curettage with high-speed burring was associated with excellent local control and few complications, making it a desirable surgical option for CMF.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Fellows Forum: A Multidisciplinary Core Curriculum Model for Surgical Oncology Fellowships","authors":"Irene Wapnir,&nbsp;Kimberly H. Allison,&nbsp;Sarah M. Pittman,&nbsp;Jacqueline Tsai","doi":"10.1002/jso.70336","DOIUrl":"10.1002/jso.70336","url":null,"abstract":"<div>\u0000 \u0000 <p>Subspecialty fellowship training is becoming more commonplace and medical practice more multidisciplinary. However, specialized training programs are challenged to provide a core curriculum that covers the interdisciplinary aspects of their field. Here we present a joint, interdisciplinary, interactive didactic program for breast fellowships in surgery, pathology and imaging. A yearlong core curriculum composed of topics of relevance to breast fellows involved in diagnostics and clinical care was created. Two hour long fellow-run interactive in-person sessions occur monthly. Additionally, faculty from breast subspecialties in surgery, imaging, pathology, medical oncology, cancer genetics, plastics and radiation oncology present hour-long didactic sessions on core curricular topics via virtual format.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"502-504"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends in the Use of Palliative Therapy in Stage IV Rectal Cancer in the United States","authors":"Michal Perets,&nbsp;Noam Kahana,&nbsp;Michael R. Freund,&nbsp;Nir Horesh,&nbsp;Maher Al Khaldi,&nbsp;Zubair Bayat,&nbsp;Sameh Hany Emile","doi":"10.1002/jso.70322","DOIUrl":"10.1002/jso.70322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Palliative-intent therapies are a key component in the management of metastatic rectal cancer; however, contemporary national trends and disparities in their utilization remain incompletely characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using the National Cancer Database (NCDB) from 2012 to 2023. Adult patients with stage IV rectal adenocarcinoma were included. Palliative therapy was defined using the NCDB variable indicating treatment administered with non-curative intent. Temporal trends were evaluated overall and stratified by facility type and median household income. Multivariable logistic regression was performed to identify independent predictors of palliative therapy utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 43 443 patients were included, of whom 8931 (20.6%) received palliative-intent therapy. Utilization increased significantly over time, from 16.2% in 2012 to 25.6% in 2023 (<i>p</i> &lt; 0.001). Systemic therapy was the most frequently used modality and increased over time, while surgical palliation declined substantially. Immunotherapy use rose markedly in later years. Palliative therapy utilization increased across all facility types. Across all income strata, utilization also increased, with the most pronounced rise among patients from lower-income areas. On multivariable analysis, lower income (OR 1.82, 95% CI 1.21–2.74), brain metastases (OR 5.75, 95% CI 1.76–18.70), and immunotherapy use (OR 1.65, 95% CI 1.24–2.21) were independently associated with increased odds of receiving palliative therapy, whereas primary tumor resection was associated with reduced utilization (OR 0.45, 95% CI 0.32–0.61).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this large national cohort, palliative therapy utilization increased modestly over time, with a shift from surgical to systemic approaches. These patterns, observed across diverse healthcare settings and socioeconomic groups, reflect the evolving integration of palliative-intent treatment in the modern management of metastatic rectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"564-573"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Transformation of Perianal Fistulas: A Systematic Review of the Literature","authors":"Parbatraj Regmi,&nbsp;Sagar Mani Regmi,&nbsp;Vijay Pratap Sah,&nbsp;Bikash Kumar Sah,&nbsp;Abhijeet Kumar,&nbsp;Tomas Janusonis,&nbsp;Zygimantas Juodeikis,&nbsp;Darius Cincikas,&nbsp;Alfredas Kilius,&nbsp;Ali A. Safik,&nbsp;Nunoo-Mensah Joseph,&nbsp;Narimantas Evaldas Samalavicius,&nbsp;Rakesh Kumar Gupta","doi":"10.1002/jso.70321","DOIUrl":"10.1002/jso.70321","url":null,"abstract":"<div>\u0000 \u0000 <p>Malignant transformation of a perianal fistula is rare, predominantly associated with chronic fistula. Carcinogenesis is presumably initiated by chronic inflammation, and its mechanism is not clearly understood. We aimed to study the clinicopathologic characteristics and treatment outcomes of patients with malignant perianal fistula. A systematic literature search was performed on the electronic databases of PubMed, Scopus, and Web of Knowledge. A single-arm meta-analysis of non-comparative studies was performed using OpenMeta[Analyst] software. Eleven retrospective studies, including 172 patients (M: 135/F: 37), were included. The mean age of the patients was 56.89 years, and the most frequent presenting complaint was pain. The estimated mean duration of Crohn's disease (CD) was 30.61 years, and the mean duration of fistula before diagnosis was 17.92 years. The most commonly performed procedure was abdominoperineal resection (APR) and the most common histopathological subtype was adenocarcinoma. During the mean follow-up time of 40.56 months, 20.16% of patients had recurrence, and 35.62% of patients died. The pathophysiology of fistula-associated cancer is not well known, has diagnostic challenges, and the literature is sparse in predicting prognosis.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"481-489"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Institutional Radiotherapy Patient Volume on Postoperative and Oncologic Outcomes After Neoadjuvant Radiation for Pancreatic Cancer.","authors":"Anne Pannekoek, Raja R Narayan, Amanda Carlson, Mengyuan Ruan, Ritchell van Dams, Akhil Chawla, George Molina","doi":"10.1002/jso.70401","DOIUrl":"https://doi.org/10.1002/jso.70401","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant radiation therapy (NRT) is beneficial in gastrointestinal cancers, but its role in pancreatic ductal adenocarcinoma (PDAC) remains uncertain. It is unclear if hospital-level NRT volume is an important factor when treating PDAC with NRT.</p><p><strong>Methods: </strong>The National Cancer Database (2011-2019) was used to identify PDAC patients who received NRT followed by surgical resection. Hospital NRT volume was defined in two ways: mean annual number of patients treated for (1) PDAC and (2) esophageal/rectal cancers. Hospitals were categorized as low (<90th percentile) or high (≥90th percentile) volume. Multivariable logistic regression and Cox proportional hazards models evaluated associations between hospital NRT volume, overall survival (OS), 30-day readmission, and surgical margin status.</p><p><strong>Results: </strong>Among 2879 PDAC patients, receiving NRT at low-volume hospitals was associated with lower OS (esophageal/rectal cancer NRT hospital volume, HR 1.16, 95% CI 1.05-1.29, p = 0.005; PDAC NRT hospital volume, HR 1.25, 95% CI 1.11-1.41, p < 0.001). Annual average patient volume of NRT for PDAC at the hospital level as a continuous variable was associated with a decrease in the adjusted log odds of 30-day readmissions and positive surgical margins.</p><p><strong>Conclusions: </strong>Higher institutional NRT volume was associated with higher OS and lower 30-day readmissions and positive surgical margins among PDAC patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ewing's Sarcoma in Adults: A Predictive Nomogram and Survival Analysis of a Cohort of 937 Patients.","authors":"Jonathan Gibson, Ben Thompson, Katie Williams, Chuck Lam, Shashank Chapala, Morgan Jones, Rajesh Botchu","doi":"10.1002/jso.70395","DOIUrl":"https://doi.org/10.1002/jso.70395","url":null,"abstract":"<p><strong>Background: </strong>Ewing sarcoma is a rare malignancy of bone and soft tissue that most commonly affects children, adolescents, and young adults. Although multimodal treatment has improved survival in localised disease, outcomes remain poorer in adults, particularly in those with metastatic disease, larger tumours, or anatomically complex primary sites. Current staging systems are useful for treatment allocation but do not fully capture individual prognostic variation. This study aimed to develop and internally validate a predictive nomogram for disease-specific survival in adult patients with Ewing sarcoma.</p><p><strong>Methods: </strong>A retrospective population-based cohort study was performed using the SEER-17 database from 2000 to 2015. Adult patients aged 18 years or older with histologically confirmed primary Ewing sarcoma of bone or soft tissue were included. The primary outcome was disease-specific survival. Predictor variables included age, sex, tumour site, tumour size, metastatic status, surgery, radiotherapy, and chemotherapy. Multivariable Cox proportional hazards regression was used to identify independent prognostic factors and construct a nomogram estimating 1-, 3-, and 5-year disease-specific survival. Internal validation was performed using 150 bootstrap resamples, and clinical utility was assessed using decision curve analysis.</p><p><strong>Results: </strong>A total of 937 adult patients were included. The mean age was 33.9 years, and 556 patients were male. Extraosseous disease was the most common primary site, followed by axial bone and appendicular bone disease. Metastatic disease was present in 294 patients. Multivariable analysis identified metastatic disease, increasing age, larger tumour size, and absence of surgery as independent adverse prognostic factors. The nomogram incorporated age, clinical stage, primary site group, tumour size, surgery, and chemotherapy to estimate 1-, 3-, and 5-year disease-specific survival. Internal validation demonstrated an optimism-corrected C-index of 0.688, with acceptable calibration across the three time points. Decision curve analysis suggested that the full nomogram provided greater clinical utility than stage alone across intermediate threshold probabilities.</p><p><strong>Conclusion: </strong>This study developed and internally validated a population-based prognostic nomogram for adult patients with Ewing sarcoma. The model demonstrated acceptable discrimination and calibration, and may support individualised risk assessment, prognostic communication, and clinical decision-making. External validation in independent cohorts, incorporating molecular and treatment-intensity data, is required to further improve clinical applicability.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixing A Problem That May Not Exist: 3N2 + 1N1 Mandate Prioritizes Compliance Over Safety.","authors":"Shubham Gulati, Raja Flores, Tara Ivic-Pavlicic, Matthew Untalan, Stephanie Tuminello, Emanuela Taioli, Brian Housman","doi":"10.1002/jso.70392","DOIUrl":"https://doi.org/10.1002/jso.70392","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, the American College of Surgeons introduced Operative Standard 5.8 mandating that lymph nodes be sampled from 1 hilar (N1) station and 3 separate mediastinal (N2) stations for all lung resections with curative intent. Though lymph node assessment is necessary for staging, there is limited data to define the number of lymph nodes or the extent of dissection. We seek to clarify modern trends in mediastinal lymph node sampling.</p><p><strong>Methods: </strong>The SEER database was queried for patients who underwent surgery, 18 years and older, between 2018 and 2020 with non-small cell lung cancer. Demographics, stage, histology, and cause-of-death were compared.</p><p><strong>Results: </strong>Of 17927 NSCLC patients, 16 431 (91.7%) underwent MLNS. Percentages increased over time 91% (2018), 92% (2019), and 93% (2020). MLNS was associated with more average harvested nodes (13.5 vs. 8.2), although the number of positive lymph nodes was similar. Death from any cause and lung cancer-specific death was higher in patients that did not receive MLNS (12.2% vs 9.1% and 7.8% vs 5.3%).</p><p><strong>Conclusion: </strong>MLNS is performed in more than 91% of anatomic resections. It is not known if each satisfied the 3N2 + 1N1 threshold with evidence strong enough to demand it. Operative Standard 5.8 mandates a solution for a problem that may not exist. Threatening hospitals with loss of accreditation distracts the surgeon agency with non-clinical considerations and compromises safe choices.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}