Journal of thoracic disease · 2026
Post-operative outcomes of lung resection after perioperative chemoimmunotherapy for stage IIB-IIIB non-small-cell lung cancer in the elderly: a single center real-life experience.
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Bongiolatti Stefano, Mugnaini Giovanni, Viggiano Domenico, Gatteschi Lavinia, Tombelli Simone, Mazzoni Francesca, Caliman Enrico, Fancelli Sara, Frongia Francesco, Gonfiotti Alessandro, Voltolini Luca
Аннотация
BACKGROUND: Locally advanced non-small cell lung cancer (LA-NSCLC) needs a multidisciplinary management and patients undergoing an intentional to treat pathway have also a high risk of recurrence even after neoadjuvant chemotherapy followed by curative resection. Recently, perioperative chemoimmunotherapy (CIO) changed the treatment paradigm. However, literature is lacking in the comparison of the post-operative outcomes in elderly patients. The aim of this study was to assess the post-operative results of perioperative CIO in patients aged ≥70 years.
METHODS: We conducted a single-center retrospective analysis on patients with clinical stage IIB-IIIB NSCLC who underwent treatment between January 2015 and June 2025. We compared post-operative outcomes of patients who received perioperative CIO with a control group of patients who received standard chemotherapy stratifying the study population focusing on elderly patients.
RESULTS: In the study period we identified 174 patients with stage IIB-IIIB NSCLC underwent lung surgery after standard chemotherapy (n=121) or CIO (n=53) and among these elderly represented 42.9% and 32.1% respectively. Ninety-day mortality was 2.4% vs. 0%. At least one complication was observed in 47.9% vs. 32.1%, P=0.07, whereas major complications (Clavien-Dindo > 3b) were developed in 11.5% vs. 1%, respectively (P=0.07). In the elderly population, major complications were observed in 13.46% vs. 0% (P=0.02). Pneumonectomy and DLCO% less than 60% of the predicted were associated with an increased risk of complications at the univariate analysis, whereas video-assisted thoracoscopic surgery (VATS) and CIO were associated with a decrease. The multivariable analysis model did not show any significant predictive factor for the development of post-operative complications.
CONCLUSIONS: Lung resection after perioperative CIO is feasible and safe even in elderly patients, without major or life-threatening complications.
METHODS: We conducted a single-center retrospective analysis on patients with clinical stage IIB-IIIB NSCLC who underwent treatment between January 2015 and June 2025. We compared post-operative outcomes of patients who received perioperative CIO with a control group of patients who received standard chemotherapy stratifying the study population focusing on elderly patients.
RESULTS: In the study period we identified 174 patients with stage IIB-IIIB NSCLC underwent lung surgery after standard chemotherapy (n=121) or CIO (n=53) and among these elderly represented 42.9% and 32.1% respectively. Ninety-day mortality was 2.4% vs. 0%. At least one complication was observed in 47.9% vs. 32.1%, P=0.07, whereas major complications (Clavien-Dindo > 3b) were developed in 11.5% vs. 1%, respectively (P=0.07). In the elderly population, major complications were observed in 13.46% vs. 0% (P=0.02). Pneumonectomy and DLCO% less than 60% of the predicted were associated with an increased risk of complications at the univariate analysis, whereas video-assisted thoracoscopic surgery (VATS) and CIO were associated with a decrease. The multivariable analysis model did not show any significant predictive factor for the development of post-operative complications.
CONCLUSIONS: Lung resection after perioperative CIO is feasible and safe even in elderly patients, without major or life-threatening complications.