Impact of Neoadjuvant Therapy, Tumor Size and Surgical Approach on Conversion to Open Thoracotomy During Lobectomy.
[BACKGROUND] Neoadjuvant therapy options for non-small cell lung cancer (NSCLC) are increasingly utilized prior to minimally invasive resection.
- p-value p<0.001
APA
Pohlman A, Marten A, et al. (2026). Impact of Neoadjuvant Therapy, Tumor Size and Surgical Approach on Conversion to Open Thoracotomy During Lobectomy.. The Annals of thoracic surgery. https://doi.org/10.1016/j.athoracsur.2026.03.046
MLA
Pohlman A, et al.. "Impact of Neoadjuvant Therapy, Tumor Size and Surgical Approach on Conversion to Open Thoracotomy During Lobectomy.." The Annals of thoracic surgery, 2026.
PMID
41933782
Abstract
[BACKGROUND] Neoadjuvant therapy options for non-small cell lung cancer (NSCLC) are increasingly utilized prior to minimally invasive resection. These operations are generally more challenging and have higher rates of conversion to open surgery. In this context, we compare peri-operative outcomes of robotic and video-assisted thoracoscopic surgery (VATS) after neoadjuvant therapy.
[METHODS] We used national hospital-level data to identify adult patients diagnosed with stage II-III NSCLC undergoing minimally invasive lobectomy after neoadjuvant chemo-immunotherapy, chemo-radiotherapy, or chemotherapy alone between 2010-2022. Patients were split into robotic and VATS cohorts. The primary outcome was conversion to open surgery, and secondary outcomes included lymph node yield, length of stay, readmission, 30- and 90-day mortality. Multivariable logistic and negative binomial regressions were created to account for patient demographics and tumor characteristics.
[RESULTS] Of 3,937 patients fitting inclusion criteria, 515 (13.1%) were converted to open, including 15.1% after chemo-radiotherapy, 12.8% after chemotherapy alone, and 9.6% after chemo-immunotherapy (p<0.001). Robotic surgery was performed in 1,745 (44.3%) patients with 137 (7.9%) conversions, and VATS was used in 2,192 (55.7%) patients with 378 (17.2%) conversions (p<0.001). VATS was independently associated with conversion to open thoracotomy (aOR 1.98, p<0.001). All other short-term outcomes were similar between groups.
[CONCLUSIONS] Conversions from minimally invasive to open surgery occur in over 1 in 10 patients receiving neoadjuvant therapy for lung cancer. The robotic approach is associated with a 54% relative risk reduction in open conversions when compared to VATS.
[METHODS] We used national hospital-level data to identify adult patients diagnosed with stage II-III NSCLC undergoing minimally invasive lobectomy after neoadjuvant chemo-immunotherapy, chemo-radiotherapy, or chemotherapy alone between 2010-2022. Patients were split into robotic and VATS cohorts. The primary outcome was conversion to open surgery, and secondary outcomes included lymph node yield, length of stay, readmission, 30- and 90-day mortality. Multivariable logistic and negative binomial regressions were created to account for patient demographics and tumor characteristics.
[RESULTS] Of 3,937 patients fitting inclusion criteria, 515 (13.1%) were converted to open, including 15.1% after chemo-radiotherapy, 12.8% after chemotherapy alone, and 9.6% after chemo-immunotherapy (p<0.001). Robotic surgery was performed in 1,745 (44.3%) patients with 137 (7.9%) conversions, and VATS was used in 2,192 (55.7%) patients with 378 (17.2%) conversions (p<0.001). VATS was independently associated with conversion to open thoracotomy (aOR 1.98, p<0.001). All other short-term outcomes were similar between groups.
[CONCLUSIONS] Conversions from minimally invasive to open surgery occur in over 1 in 10 patients receiving neoadjuvant therapy for lung cancer. The robotic approach is associated with a 54% relative risk reduction in open conversions when compared to VATS.