{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T16:04:07Z","timestamp":1780329847207,"version":"3.54.1"},"reference-count":12,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Current lung cancer guidelines recommend lymph node sampling (LNS) with the 3\u2009+\u20091 rule, which recommends station-based sampling with at least 3 N2 (mediastinal) and 1 N1 (hilar) nodal stations. Although there is oncologic benefit to rigorous LNS, potential negative impacts on surgical outcomes have not been well investigated. As adoption of the 3\u2009+\u20091 rule increases given its formalization as guideline-concordant care, associations with adverse outcomes are crucial to characterize.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether satisfying the 3\u2009+\u20091 rule is associated with increased postoperative complications.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used the Society of Thoracic Surgeons General Thoracic Database, which was queried for patients with clinical stage T1 to T3, N0, M0 non\u2013small cell lung cancer (NSCLC) who underwent surgical resection with known LNS between July 1, 2021, and January 1, 2023. Statistical analysis was performed from March 2024 to March 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n A propensity match was conducted to compare the postoperative complication rate by 3\u2009+\u20091 LNS status.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Data on demographic characteristics were collected and analyzed. Primary outcomes included postoperative complications, such as arrhythmias, pleural effusion requiring drainage, blood transfusion, prolonged air leak, therapeutic bronchoscopy, pneumonia, respiratory failure, bronchopleural fistula, pulmonary embolism, pneumothorax, prolonged ventilatory support, myocardial infarction, and sepsis. Thirty-day mortality and readmission rates were also evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The cohort included 28\u202f439 patients (median [IQR] age, 69 [66-75] years; 4791 [59.5%] female). There were 18\u202f939 patients (66.6%) who satisfied the 3\u2009+\u20091 rule. In the unadjusted group, the 3\u2009+\u20091 cohort had longer median (IQR) operating room duration (224 [178-281] vs 210 [161-273] minutes,\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and rates of pathologic upstaging (2520 [13.3%] vs 922 [9.7%],\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). In the postmatch analysis, there were no other significant differences in postoperative complication rates, and the aforementioned associations in the 3\u2009+\u20091 group were no longer observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of patients with NSCLC, the 3\u2009+\u20091 rule was not associated with increased postoperative complications. This study\u2019s findings suggest support for the continued use of this strategy in terms of overall safety profile.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.15894","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T15:30:40Z","timestamp":1780327840000},"page":"e2615894","source":"Crossref","is-referenced-by-count":0,"title":["Lymph Node Dissection and Postoperative Complications After Lung Cancer Resection"],"prefix":"10.1001","volume":"9","author":[{"given":"Isheeta","family":"Madeka","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Noueihed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Woodroof","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shale","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Chicago Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Rshaidat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory L.","family":"Whitehorn","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland Medical Center, 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