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Sociedad Espanola de Neumologia y Cirugia ToracicaThoracic Surgery2026advanced

SEPAR-SECT recommendations for perioperative invasive mediastinal staging of non-small cell lung cancer.

Published by Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and Spanish Society of Thoracic Surgeons (SECT) [2]

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Summary

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Accurate mediastinal nodal staging is essential for the management of non-small cell lung cancer (NSCLC), as it refines prognosis, guides multimodal treatment, and improves survival [2]. This joint consensus document updates and expands the 2011 SEPAR guidelines, incorporating the 9th edition of the TNM classification [2].

Non-small cell lung cancermediastinal staginglymphadenectomy

Key Takeaways

  • 1
    Invasive mediastinal staging is not required for T1a and T1b tumours without radiological evidence of nodal disease, regardless of their location. [1]
  • 2
    N1 disease is recognized as a setting associated with a high risk of unsuspected mediastinal involvement. [1]
  • 3
    For cases with intermediate suspicion of mediastinal disease, surgical staging techniques demonstrate superior accuracy compared with endosonography alone. [1]
  • 4
    The consensus integrates the International Association for the Study of Lung Cancer (IASLC) definitions of completeness of resection and proposes quality standards for intraoperative lymphadenectomy. [1]

What's New in This Version

This joint consensus document from SEPAR and SECT updates and expands the 2011 SEPAR guidelines, incorporating the 9th edition of the TNM classification and extending recommendations to the entire perioperative setting, including both preoperative and intraoperative mediastinal staging. [1]

Key Recommendations

T1a/T1b Tumours

  • REC-1

    Invasive mediastinal staging is not required for T1a and T1b tumours without radiological evidence of nodal disease, regardless of their location. [1]

    Staging

N1 Disease

  • REC-2

    Particular attention is given to the role of N1 disease, which is recognized as a setting associated with a high risk of unsuspected mediastinal involvement. [1]

    Staging

Intermediate Suspicion

  • REC-3

    For cases with intermediate suspicion of mediastinal disease, surgical staging techniques demonstrate superior accuracy compared with endosonography alone. [1]

    Staging

Scope & Objectives

Clinical Topic

Perioperative Invasive Mediastinal Staging of Non-small Cell Lung Cancer [1, 2]

Objectives

To update and expand the 2011 SEPAR guidelines, incorporating the 9th edition of the TNM classification and extending recommendations to the entire perioperative setting, including both preoperative and intraoperative mediastinal staging [2].

Target Patient Population

Patients with non-small cell lung cancer (NSCLC) undergoing perioperative staging [1, 2].

Target Providers

PulmonologistsThoracic Surgeons

Patient Criteria & Setting

Therapeutic Area

Oncology [2]

Guideline Scope

StagingDiagnosis

Care Settings

PerioperativePreoperativeIntraoperative

Authors & Contributors

Department of Thoracic SurgeryHospital Universitari MútuaTerrassaUniversitat de BarcelonaTerrassaSpain; Department of Morphological SciencesSchool of Medicine and Health SciencesUniversitat Autònoma de BarcelonaBellaterraSpain [1]

Guideline Features

Flowcharts includedBased on systematic reviewMultidisciplinary

Learning Context

Difficulty

advanced

Learning Paths

NSCLC StagingInvasive Mediastinal StagingPreoperative StagingIntraoperative StagingSurgical Staging