Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Following Neoadjuvant Immunochemotherapy in Resectable Stage III Non-Small Cell Lung Cancer Among Chinese Populations: A Multi-Center Retrospective Cohort Study

Hanbo Pan; Hang Chen; Weicheng Kong; Junwei Ning; Zhen Ge; Yu Tian; Ningyuan Zou; Hongda Zhu; Jiaqi Zhang; Yixing Tao; Zenan Gu; Min Zheng; Guomo Ruan; Long Jiang; Ziming Li; Jia Huang; Chengwei Zhou; Guodong Xu; Qingquan Luo

doi:10.1016/j.cllc.2024.03.008

Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Following Neoadjuvant Immunochemotherapy in Resectable Stage III Non-Small Cell Lung Cancer Among Chinese Populations: A Multi-Center Retrospective Cohort Study

Clin Lung Cancer. 2024 Apr 2:S1525-7304(24)00042-1. doi: 10.1016/j.cllc.2024.03.008. Online ahead of print.

Authors

Hanbo Pan¹, Hang Chen², Weicheng Kong³, Junwei Ning⁴, Zhen Ge⁵, Yu Tian¹, Ningyuan Zou¹, Hongda Zhu¹, Jiaqi Zhang¹, Yixing Tao¹, Zenan Gu¹, Min Zheng⁴, Guomo Ruan⁶, Long Jiang¹, Ziming Li⁷, Jia Huang⁸, Chengwei Zhou⁹, Guodong Xu¹⁰, Qingquan Luo¹¹

Affiliations

¹ Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
³ Department of Thoracic Surgery, Putuo District People's Hospital, Zhoushan, China.
⁴ Department of Thoracic Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ Department of Cardiothoracic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China.
⁶ Department of Clinical Medicine, Wenzhou People's Hospital, Shanghai University School of Medicine, Wenzhou, China.
⁷ Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: huangjiadragon@126.com.
⁹ Department of Cardiothoracic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China. Electronic address: fyzhouchengwei@nbu.edu.cn.
¹⁰ Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China. Electronic address: xuguodong@nbu.edu.cn.
¹¹ Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: luoqingquan@shsmu.edu.cn.

PMID: 38705833
DOI: 10.1016/j.cllc.2024.03.008

Abstract

Background: Immune checkpoint inhibitors have revolutionized non-small cell lung cancer (NSCLC) treatment but may pose greater technical challenges for surgery. This study aims to assess the feasibility and oncological effectiveness of video-assisted thoracoscopic surgery (VATS) for resectable stage III NSCLC after neoadjuvant immunochemotherapy.

Methods: Initial stage IIIA-IIIB NSCLC patients with neoadjuvant immunochemotherapy undergoing either VATS or open lobectomy at 6 medical centers during 2019-2023 were retrospectively identified. Perioperative outcomes and 2-year survival was analyzed. Propensity-score matching (PSM) was employed to balance patient baseline characteristics.

Results: Among the total 143 patients, PSM yielded 62 cases each for VATS and OPEN groups. Induction-related adverse events were comparable between the 2 groups. VATS showed a 14.5% conversion rate. Notably, VATS decreased numeric rating scales for postoperative pain, shortened chest tube duration (5[4-7] vs. 6[5-8] days, P = .021), reduced postoperative comorbidities (21.0% vs. 37.1%, P = .048), and dissected less N1 lymph nodes (5[4-6] vs. 7[5-9], P = .005) compared with thoracotomy. Even when converted, VATS achieves perioperative outcomes equivalent to thoracotomy. Additionally, over a median follow-up of 29.5 months, VATS and thoracotomy demonstrated comparable 2-year recurrence-free survival (77.20% vs. 73.73%, P = .640), overall survival (87.22% vs. 88.00%, P = .738), cumulative incidences of cancer-related death, and recurrence patterns. Subsequent subgroup comparisons and multivariate Cox analysis likewise revealed no statistical difference between VATS and thoracotomy.

Conclusion: VATS is a viable and effective option for resectable stage III NSCLC patients following neoadjuvant immunochemotherapy, leading to decreased surgical-related pain, earlier chest tube removal, reduced postoperative complications, and similar survival outcomes compared to thoracotomy.

Keywords: Immune checkpoint inhibitors; Lobectomy; Minimally Invasive surgery; Perioperative outcomes; Survival.