Objective

To assess the level of adherence of the departmental practice with the European Society of Thoracic Surgery guidelines on intra-operative lymph node sampling as well as evaluating the impact of displaying lymph node sampling poster aides in theatres.

Methods

Retrospective review of pathology reports of cases with lung resection during the period of 01/10/2012 to 28/03/2013 was performed. Subsequently, a poster of the lymph node sampling was displayed in theatres to aid enhanced intra-operative mediastinal lymph node sampling rate. Further retrospective review of lung resection cases for a period of 01/03/2014 to 01/06/2014 was conducted. Data matrix was produced and analysis was performed with the Excel and SPSS software.

Results

For right upper lobectomy, sampling of 2R, 4R and 7 improved from 46.9%, 78% and 56% to 77.8%, 97.2% and 94.4% respectively. For Right Lower Lobectomy, the sampling rate of stations 4R, 7, 8 and 9 improved from 17.6%, 70.6%, 5.9% and 58.8% to 66.7%, 100%, 66.7% and 100% respectively. For left upper lobectomy, sampling rate changed from 78.3%, 0% and 34.8% to 90%, 30% and 80% respectively. For Left Lower Lobectomy, sampling of 7, 8 and 9 improved from 40%, 20% and 70% to 72.7%, 54.5% and 90.9%.

Conclusion

Overall, the intra-operative mediastinal lymph node sampling rate has improved as a result of promotion of awareness about the European Society of Thoracic Surgery guidelines and the display of lymph node sampling poster in each thoracic theatre which was used as a prompt. Furthermore, we recommend to aim to achieve full sampling rate as per the guidelines.