Feasıbılıty and safety of vıdeo-assısted thoracıc surgery after neoadjuvant chemoımmunotherapy ın non-small cell lung cancer: A sıngle-centre experıence.

Abstract

Introduction: Neoadjuvant chemoimmunotherapy has emerged as a promising strategy in the multimodal treatment of locally advanced non-small cell lung cancer (NSCLC). However, concerns remain regarding its impact on surgical complexity and the feasibility of video-assisted thoracic surgery (VATS) in this setting.

Patients and methods: Between April 2021 and August 2024, 17 patients who received neoadjuvant chemoimmunotherapy (PD-1 inhibitor plus chemotherapy) underwent lung resection. A significant proportion of cases (58.8%) were managed through VATS (primarily biportal approach), with no conversions to open surgery. The remaining patients underwent thoracotomy or Dartavelle incision due to anatomical complexity.

Results: The mean operative time was 135 ± 25 min for VATS and 172.9 ± 30 min for open surgery (P = 0.068). While hospital stay was similar between VATS (5.9 days) and open surgery (6.4 days) (P = 0.449), ıntensive care unit stay was significantly shorter in the VATS group (0.5 vs. 1.3 days, P = 0.007). Significant tumour downstaging was observed in 88.2% of patients, with four achieving complete pathological response and three demonstrating a major pathological response (P < 0.05). Post-operative complications were observed in 41.2% of patients, but no 90-day mortality occurred.

Conclusion: VATS appears to be a feasible and safe approach for selected NSCLC patients after neoadjuvant chemoimmunotherapy, demonstrating favourable short-term outcomes. These findings contribute to the growing evidence supporting minimally invasive surgery as a viable option in complex, locally advanced cases following immunotherapy.