JTCVS open · 2026
Feasibility and oncologic outcomes of minimally invasive surgery after induction chemoimmunotherapy for non-small cell lung cancer.
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Comacchio Giovanni M, Sewell Marisa, Tan Kay See, Toumbacaris Nicolas, Bott Matthew J, Adusumilli Prasad S, Chidi Alexis, Gray Katherine, Huang James, Isbell James M, Park Bernard J, Rocco Gaetano, Rusch Valerie W, Sihag Smita, Jones David R, Molena Daniela
Аннотация
OBJECTIVE: We evaluated the feasibility and long-term outcomes of minimally invasive surgery (MIS) after neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer (NSCLC).
METHODS: Patients with stage IB-IIIB NSCLC who underwent induction immunotherapy followed by surgery (2015-2022) were included. Overall and event-free survival were estimated using the Kaplan-Meier approach. Cox regression was used to quantify associations between clinical and pathologic variables and survival outcomes.
RESULTS: In total, 69 patients met the inclusion criteria (MIS, n = 38; open surgery, n = 31). Patients who underwent open surgery had larger tumors (P < .001), more-frequent extended resection (P = .007), more major complications (P = .03), and longer in-hospital stay (P = .002), compared with patients who underwent MIS. The rate of conversion to open surgery in the MIS group was 16% (6/38). Histologic subtype (P = .057), completeness of resection (P > .9), response to treatment (P > .9), and stage (P = .6) were not statistically different between groups. Five-year event-free and overall survival in the MIS patients were 72% and 80%, respectively. Among all patients, pathologic N2 disease (hazard ratio [HR], 3.04; 95% CI, 1.1-8.38; P = .031) and upstaging (HR, 2.57; 95% CI, 1.05-6.34; P = .04) were associated with a greater risk of recurrence. Major pathologic response was associated with longer event-free survival (HR, 0.22; 95% CI, 0.05-0.93; P = .039). Programmed death-ligand 1 level (HR, 1.02; 95% CI, 1.01-1.04; P = .007) and tumor dimensional reduction after treatment (HR, 0.96; 95% CI, 0.93-0.99; P = .016) were associated with major pathologic response.
CONCLUSIONS: MIS after induction immunotherapy is feasible and does not compromise long-term oncologic outcomes.
METHODS: Patients with stage IB-IIIB NSCLC who underwent induction immunotherapy followed by surgery (2015-2022) were included. Overall and event-free survival were estimated using the Kaplan-Meier approach. Cox regression was used to quantify associations between clinical and pathologic variables and survival outcomes.
RESULTS: In total, 69 patients met the inclusion criteria (MIS, n = 38; open surgery, n = 31). Patients who underwent open surgery had larger tumors (P < .001), more-frequent extended resection (P = .007), more major complications (P = .03), and longer in-hospital stay (P = .002), compared with patients who underwent MIS. The rate of conversion to open surgery in the MIS group was 16% (6/38). Histologic subtype (P = .057), completeness of resection (P > .9), response to treatment (P > .9), and stage (P = .6) were not statistically different between groups. Five-year event-free and overall survival in the MIS patients were 72% and 80%, respectively. Among all patients, pathologic N2 disease (hazard ratio [HR], 3.04; 95% CI, 1.1-8.38; P = .031) and upstaging (HR, 2.57; 95% CI, 1.05-6.34; P = .04) were associated with a greater risk of recurrence. Major pathologic response was associated with longer event-free survival (HR, 0.22; 95% CI, 0.05-0.93; P = .039). Programmed death-ligand 1 level (HR, 1.02; 95% CI, 1.01-1.04; P = .007) and tumor dimensional reduction after treatment (HR, 0.96; 95% CI, 0.93-0.99; P = .016) were associated with major pathologic response.
CONCLUSIONS: MIS after induction immunotherapy is feasible and does not compromise long-term oncologic outcomes.