Perioperative Outcomes of Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC

Abstract

BackgroundNeoadjuvant chemoimmunotherapy becomes more widespread in the treatment of NSCLC, but few studies have reported the details of surgical techniques and perioperative challenges following neoadjuvant chemoimmunotherapy until now. The primary aim of our study was to address the feasibility and safety of pulmonary resection after neoadjuvant chemoimmunotherapy via different surgical approaches, video-assisted thoracoscopic surgery (VATS) and open thoracotomy.MethodsPatients with an initial diagnosis of clinical stage IB-IIIB(T3-4N2) NSCLC, who received neoadjuvant chemoimmunotherapy and surgery between January 2019 and August 2021 were included. Patients were retrospectively divided into two groups (VATS, and thoracotomy), and differences in perioperative, oncological, and survival outcomes were compared.ResultsIn total, there were 131 NSCLC patients included. Surgery was delayed beyond 42 days in 21 patients (16.0%), and radical resection (R0) was achieved in 125 cases (95.4%). Lobectomy was the principal method of pulmonary resection (102 cases, 77.9%) and pneumonectomy was performed in 11 cases (8.4%). Postoperative complications within 30 days occurred in 28 patients (21.4%), and no 90-day mortality was recorded. There were 53 patients (38.5%) treated with VATS, and 78 (59.5%) with open thoracotomy. VATS could achieve similar definitive resection rates, postoperative recovery courses, comparable morbidities, and equivalent RFS rates(p>0.05), with the advantages of reduced operative time (160.1 ± 40.4 vs 177.7 ± 57.7 min, p=0.042), less intraoperative blood loss (149.8 ± 57.9 vs 321.2 ± 72.3 ml, p=0.021), and fewer intensive care unit(ICU) stays after surgery (3.8% vs 20.5%, p=0.006) compared with open thoracotomy. However, the mean number of total lymph nodes resected was lower in the VATS group (19.5 ± 7.9 vs 23.0 ± 8.1, p=0.013). More patients in the thoracotomy group received bronchial sleeve resection/bronchoplasty (53.8% vs 32.1%, p=0.014) and vascular sleeve resection/angioplasty (23.1% vs 3.8%, p=0.003). After propensity score matching (PSM) analysis, VATS still had the advantage of fewer ICU stays after surgery (2.3% vs. 20.5%, p=0.007).ConclusionsOur results have confirmed that pulmonary resection following neoadjuvant PD-1 inhibitors plus chemotherapy is safe and feasible. VATS could achieve similar safety, definitive surgical resection, postoperative recovery, and equivalent oncological efficacy as open thoracotomy, with the advantage of fewer ICU stays after surgery.

Early outcomes of minimally invasive surgery versus thoracotomy for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a multi-center propensity score- matched study

“…Recent publications have shown that MIS is associated with a faster postoperative recovery over thoracotomy for NSCLC patients following induction therapy than thoracotomy [30,31]. Of note, our study revealed that MIS also shortened chest tube duration than open lobectomy, suggesting that this advantage of MIS also exists for patients with immunochemotherapy induction, which was in line with a previous study but con icted with another [20,28]. Moreover, we found that the two surgical approaches led to similar postoperative hospitalization.…”

Subsequent surgical treatment or maintenance immunotherapy in stage III lung cancer patients achieving a favorable response following neoadjuvant immunotherapy: A matched retrospective cohort study from the surgical perspective

“…16 While several articles have mentioned the use of MIS in the surgical treatment of lung cancer patients after immunotherapy, 16,17 reports directly comparing MIS with thoracotomy have been limited. Recently, Zhang et al 18 conducted a retrospective study among stage IB-IIIB lung cancer patients and found that VATS achieved comparable efficacy to open surgery, with shorter ICU stays for patients, indicating the safety, efficacy, and feasibility of VATS as a surgical strategy for patients after immunotherapy. 19 Our results similarly demonstrated that patients who underwent MIS after immunotherapy had equally favorable prognoses to those who underwent thoracotomy.…”

Case Report: Uniportal robot-assisted thoracoscopic double-sleeve lobectomy after neoadjuvant immunotherapy

“…The result indicates that radiotherapy or chemoradiotherapy could increase the risk of pulmonary complications ( 24 ). However, neither chemoimmunotherapy nor chemotherapy has been reported to pose a negative effect on postoperative recovery of sleeve resections ( 25 , 26 ). In the presented case, the patient received neoadjuvant immunotherapy alone and manifested a smooth postoperative recovery.…”