Perioperative Outcomes of Minimally Invasive Surgery After Systemic Neoadjuvant Therapy in Patients with Non-Small Cell Lung Cancer

P0186 

Abstract Submission 

David Rice (1), Shanique Ries (2), Amber Shahid (3), Claudia Pedroza (4), Kyle Mitchell (5), Zamaan Hooda (3), Mara Antonoff (6), Wayne Hofstetter (7), Reza Mehran (8), Ravi Rajaram (3), Stephen Swisher (5), Garrett Walsh (8), Ara Vaporciyan, MD (9)

(1) MD Anderson Cancer Center, Houston, TX, (2) University of Texas MD Anderson Cancer Center, Stamford, CT, (3) University of Texas MD Anderson Cancer Center, Houston, TX, (4) The University of Texas Health Science Center, Houston, TX, (5) The University of Texas MD Anderson Cancer Center, Houston, TX, (6) MD Anderson Cancer Center, Bellaire, TX, (7) The University of Texas M.D. Anderson Cancer Center, Houston, TX, (8) University of Texas, Houston, TX, (9) UT MD Anderson Cancer Center, Bellaire, TX

*David Rice    -  Contact Me
MD Anderson Cancer Center

Shanique Ries    -  Contact Me
University of Texas MD Anderson Cancer Center

Amber Shahid    -  Contact Me
University of Texas MD Anderson Cancer Center

Claudia Pedroza    -  Contact Me
The University of Texas Health Science Center

Kyle Mitchell    -  Contact Me
The University of Texas MD Anderson Cancer Center

Zamaan Hooda    -  Contact Me
University of Texas MD Anderson Cancer Center

*Mara Antonoff    -  Contact Me
MD Anderson Cancer Center

*Wayne Hofstetter    -  Contact Me
The University of Texas M.D. Anderson Cancer Center

*Reza Mehran    -  Contact Me
University of Texas

Ravi Rajaram    -  Contact Me
University of Texas MD Anderson Cancer Center

*Stephen Swisher    -  Contact Me
The University of Texas MD Anderson Cancer Center

*Garrett Walsh    -  Contact Me
University of Texas

*Ara Vaporciyan, MD    -  Contact Me
UT MD Anderson Cancer Center

Shanique Ries    -  Contact Me
University of Texas MD Anderson Cancer Center

Title: Perioperative Outcomes of Minimally Invasive Surgery After Systemic Neoadjuvant Therapy in Patients with Non-Small Cell Lung Cancer
Authors: Shanique Ries, Amber Shahid, Claudia Pedroza, Kyle Mitchell, Zamaan Hooda, Mara B. Antonoff, Wayne L. Hofstetter, Reza J. Mehran, Ravi Rajaram, Stephen G. Swisher, Garrett L. Walsh, Ara A. Vaporciyan, David C. Rice
Objective: Increased use of neoadjuvant immunotherapy and targeted therapies has revolutionized the management of locally advanced Non-Small Cell Lung Cancer (NSCLC). While these treatments enhance tumor response and survival, they also introduce surgical challenges, especially for minimally invasive surgery (MIS). We assessed perioperative outcomes among patients undergoing MIS and open thoracotomy (OT) for resection of NSCLC following systemic neoadjuvant therapy (NeoRx).
Methods: A review was conducted using a prospective clinical database of patients with NSCLC treated by surgical resection after NeoRx between January 2014 and December 2023. Patients were grouped according to surgical approach. Inverse Probability of Treatment Weighting (IPTW) was used to balance relevant clinical variables. Weighted logistic regression models compared perioperative outcomes between OT and MIS and between video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). Multivariable logistic regression analysis (MVA) assessed risk factors for conversion to OT.
Results: Of 2,137 patients, 546 (25.5%) had NeoRx. 405 (74.2%) underwent OT and 141 (25.8%) had MIS, including 82 (58.2%) RATS and 59 (41.8%) VATS. Analysis with IPTW revealed OT had shorter operation time (mean ∆ 43 min, p<0.001) but higher blood loss (mean ∆ 115 ml, p<0.001) and higher risk for atrial arrhythmia (OR 3.02, p=0.02). Conversion to OT occurred in 20 (14.2%) MIS patients and was higher for VATS than RATS (25.4% vs. 6.1%, OR 15.3, p<0.001). Rate of R0 resection was slightly lower with VATS than RATS (89% vs. 96%, OR 4.52, p=0.029). In MVA, conversion to OT was independently associated with VATS (OR 7.31, p=0.009), non-adenocarcinoma histology (OR 6.12, p=0.017) and year of surgery (OR 1.4, p=0.03).
Conclusion: Apart from lower blood loss, less atrial arrhythmias and longer operative times, lung resection by MIS after NeoRx has similar perioperative outcomes to thoracotomy. MIS is feasible in this patient population and RATS and adenocarcinoma histology are associated with a lower risk of conversion.

Lung Cancer