Minimally invasive resection of non-small cell lung cancer after chemoimmunotherapy: A multicenter study in academic hospitals.

[OBJECTIVE] We sought to analyze the outcomes of minimally invasive surgery and open resection of non-small cell lung cancer after neoadjuvant chemoimmunotherapy relative to treatment response.

[METHODS] Data from 5 centers in the United States and Germany were combined for all patients undergoing resection for non-small cell lung cancer after neoadjuvant chemoimmunotherapy between 2019 and 2024. Clinical and pathologic factors associated with minimally invasive surgery were analyzed. Minimally invasive surgery and open surgery outcomes were compared.

[RESULTS] A total of 207 patients were included, of whom 164 (79.2%) underwent minimally invasive surgery and 43 (20.8%) underwent open resection. Minimally invasive surgery was more commonly used for lobectomy (93.9% vs 58.8% open) and less frequently for bilobectomy (2.6% vs 14.7% open) or pneumonectomy (2.6% vs 26.5% open, P < .0001). Unplanned conversion to thoracotomy (9.1%, n = 15) occurred less often for robotic-assisted compared with video-assisted thoracoscopic surgery (4.5% vs 31%, P = .001). Open resection was used more often performed for larger residual tumors (ypT3/4, minimally invasive surgery 8.5% vs open 32.5%, P = .0002). A pathologic complete response in 39.1% of patients was an independent predictor of minimally invasive surgery (odds ratio, 10.81; 95% CI, 2.71-43.20; P = .001). Complete R0 resection was achieved in 96.1% of patients (minimally invasive surgery 98.2% vs open 88.4%, P = .003). Minimally invasive surgery was associated with shorter length of stay (adjusted median 3 days vs 7 days, P < .0001) and fewer major complications (9.1% vs 25.6%, P = .038). The 60-day mortality rate was 1%.

[CONCLUSIONS] Minimally invasive surgery is possible in most patients after neoadjuvant chemoimmunotherapy, especially after complete pathologic response, and is associated with high rates of complete resection and fast recovery. Open surgery is performed more often for patients with large residual tumors or those requiring extended resections.