{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T19:09:20Z","timestamp":1788721760574,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The SEER database was queried for patients who underwent surgery, 18 years and older, between 2018 and 2020 with non\u2010small cell lung cancer. Demographics, stage, histology, and cause\u2010of\u2010death were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2010specific death was higher in patients that did not receive MLNS (12.2% vs 9.1% and 7.8% vs 5.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MLNS is performed in more than 91% of anatomic resections. It is not known if each satisfied the 3N2\u2009+\u20091N1 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\u2010clinical considerations and compromises safe choices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70392","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T18:51:30Z","timestamp":1788720690000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fixing A Problem That May Not Exist: 3N2\u2009+\u20091N1 Mandate Prioritizes Compliance Over Safety"],"prefix":"10.1002","author":[{"given":"Shubham","family":"Gulati","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7718-7422","authenticated-orcid":false,"given":"Raja","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Ivic\u2010Pavlicic","sequence":"additional","affiliation":[{"name":"Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4616-2744","authenticated-orcid":false,"given":"Matthew","family":"Untalan","sequence":"additional","affiliation":[{"name":"Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Tuminello","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5734-4806","authenticated-orcid":false,"given":"Emanuela","family":"Taioli","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Tisch Cancer Institute Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6443-775X","authenticated-orcid":false,"given":"Brian","family":"Housman","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"M.Archer K.Absher L.Adams et al. Committee on Cancer Operative Standard 5.8: Pulmonary ResectionAmerican College of Surgeons https:\/\/www.facs.org\/media\/vumntxcg\/webinar_standard_5_8_pulmonary_resection.pdf."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31827457db"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2023.04.039"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000774"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2212083"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2023.07.008"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-3069"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.06.066"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2005.01.001"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2006.08.008"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.06.020"},{"key":"e_1_2_10_13_1","unstructured":"D.Ettinger D.Wood andW.AkerleyNCCN Guidelines Insights: Non\u2010Small Cell Lung Cancer. 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