Minimally invasive resection of non–small cell lung cancer after chemoimmunotherapy: A multicenter study in academic hospitals

Abstract

Objective: We sought to analyze the outcomes of minimally invasive surgery and open resection of non–small cell lung cancer after neoadjuvant chemoimmunotherapy relative to treatment response. Methods: Data from 5 centers in the United States and Germany were combined for all patients undergoing resection for non–small cell lung cancer after neoadjuvant chemoimmunotherapy between 2019 and 2024. Clinical and pathologic factors associated with minimally invasive surgery were analyzed. Minimally invasive surgery and open surgery outcomes were compared. Results: A total of 207 patients were included, of whom 164 (79.2%) underwent minimally invasive surgery and 43 (20.8%) underwent open resection. Minimally invasive surgery was more commonly used for lobectomy (93.9% vs 58.8% open) and less frequently for bilobectomy (2.6% vs 14.7% open) or pneumonectomy (2.6% vs 26.5% open, P < .0001) and fewer major complications (9.1% vs 25.6%, P = .038). The 60-day mortality rate was 1%. Conclusions: Minimally invasive surgery is possible in most patients after neoadjuvant chemoimmunotherapy, especially after complete pathologic response, and is associated with high rates of complete resection and fast recovery. Open surgery is performed more often for patients with large residual tumors or those requiring extended resections.