Photo Credit: Vladislav Stepanov

The following is a summary of “Determinants of successful minimally invasive surgery (MIS) for resectable non-small cell lung cancer (NSCLC) after neoadjuvant therapy,” published in the August 2024 issue of Surgery by Chu et al.

Minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), is now considered the standard approach for pulmonary resection in early-stage non-small cell lung cancer (NSCLC) due to its association with superior perioperative outcomes compared to thoracotomy. The extension of MIS to more advanced stages of NSCLC (Stages IB-IIIB) following neoadjuvant systemic therapy has been explored; however, the factors contributing to the success of this approach remain inadequately defined. In this study, researchers conducted a retrospective review at a single institution, drawing data from a prospectively maintained database to evaluate outcomes in patients with clinical Stage IB-IIIB NSCLC who underwent surgical resection after receiving neoadjuvant systemic therapy without radiation between 2013 and 2022. 

Patients were categorized based on the surgical approach: open surgery versus MIS. Successful MIS was specifically defined as a procedure that did not require conversion to open surgery, achieved an R0 resection (complete resection with no residual tumor), and resulted in no major morbidity (defined as ≥grade 3 complications). Statistical analyses, including intent-to-treat comparisons using the Wilcoxon rank sum test and Fisher’s exact test, were employed to assess outcomes, and multivariate analysis (MVA) was utilized to identify variables influencing the success of MIS resections. Of the 627 patients who met the study criteria, 360 (57%) underwent open surgery, while 267 (43%) were treated with MIS. Most (79.1%) of these patients received neoadjuvant platinum-based chemotherapy, while 21.9% received immunotherapy or targeted therapy, either alone or in combination with chemotherapy. Among the MIS cohort, 179 procedures (67%) were performed using VATS and 88 (33%) using RATS, with a conversion rate of 16% (n=43). Overall, 77% of MIS resections were deemed successful. 

The MVA identified the pre-treatment clinical N stage as a significant predictor of successful MIS resection. In contrast, the pre-treatment clinical T stage and the type of neoadjuvant therapy were not significant factors. These findings suggest that MIS can be successfully employed in the resection of advanced NSCLC following neoadjuvant therapy, although the presence of pre-treatment nodal disease is associated with increased risks of conversion to open surgery, major morbidity, and incomplete resection. This underscores the need for careful patient selection and thorough preoperative assessment in this context.

Source: sciencedirect.com/science/article/abs/pii/S0022522324006962