Influence of neoadjuvant immunotherapy on surgical approaches in non-small cell lung cancer: insights from a Chinese Expert Questionnaire Survey on Contemporary Practices.

[BACKGROUND] The extent to which neoadjuvant immunotherapy may complicate subsequent surgical procedures in selected cases of non-small cell lung cancer (NSCLC) is yet to be definitively established. This study was designed to explore the influence of neoadjuvant immunotherapy on the practical surgical management of NSCLC by practicing surgeons.

[METHODS] An electronic survey was methodically disseminated via WeChat groups specifically tailored to thoracic surgeons within China. The data collection encompassed demographic details, management preferences, preoperative assessments, intraoperative techniques, and postoperative outcomes to evaluate variations and challenges in surgical practices following neoadjuvant immunotherapy.

[RESULTS] The survey garnered 250 valid responses from thoracic surgeons across 25 provinces in China. Stage III central NSCLC was predominantly the context for administering neoadjuvant immunotherapy. The preferred surgical window post-neoadjuvant immunotherapy, as chosen by 81.2% of surgeons, was 4-6 weeks. Notably, 22.4% of the surgeons reported observing immune-related adverse events (irAEs), with a higher incidence noted among the more seasoned practitioners. Views on the technical complexity of surgery post-neoadjuvant immunotherapy were equally varied: 30.0% reported increased difficulty, 33.2% saw no difference, and 28.8% opined that complexity was contingent on the individual case.

[CONCLUSIONS] Within a specialized questionnaire survey targeting thoracic surgeons, perceptions varied regarding the impact of neoadjuvant immunotherapy on surgical outcomes. Overall, neoadjuvant immunotherapy was associated with tolerable adverse events and improved resectability. In this survey, whether neoadjuvant immunotherapy increases the complexity of surgical procedures remained highly contentious, physicians with more experience tended to believe that there was increased irAEs but not much impact on surgical complexity of difficulty.