Feasibility and oncologic outcomes of minimally invasive surgery after induction chemoimmunotherapy for non–small cell lung cancer

Objective We evaluated the feasibility and long-term outcomes of minimally invasive surgery (MIS) after neoadjuvant immunotherapy in patients with resectable non–small cell lung cancer (NSCLC). Methods Patients with stage IB-IIIB NSCLC who underwent induction immunotherapy followed by surgery (2015-2022) were included. Overall and event-free survival were estimated using the Kaplan-Meier approach. Cox regression was used to quantify associations between clinical and pathologic variables and survival outcomes. Results In total, 69 patients met the inclusion criteria (MIS, n=38; open surgery, n=31). Patients who underwent open surgery had larger tumors ( P < .001), more-frequent extended resection ( P = .007), more major complications ( P = .03), and longer in-hospital stay ( P = .002), compared with patients who underwent MIS. The rate of conversion to open surgery in the MIS group was 16% (6/38). Histologic subtype ( P = .057), completeness of resection ( P > .9), response to treatment ( P > .9), and stage ( P = .6) were not statistically different between groups. Five-year event-free and overall survival in the MIS patients were 72% and 80%, respectively. Among all patients, pathologic N2 disease (hazard ratio [HR], 3.04; 95% CI, 1.1-8.38; P = .031) and upstaging (HR, 2.57; 95% CI, 1.05-6.34; P = .04) were associated with a greater risk of recurrence. Major pathologic response was associated with longer event-free survival (HR, 0.22; 95% CI, 0.05-0.93; P = .039). Programmed death-ligand 1 level (HR, 1.02; 95% CI, 1.01-1.04; P = .007) and tumor dimensional reduction after treatment (HR, 0.96; 95% CI, 0.93-0.99; P = .016) were associated with major pathologic response. Conclusions MIS after induction immunotherapy is feasible and does not compromise long-term oncologic outcomes.