P182. Minimally Invasive Resection of Locoregionally Advanced NSCLC after Chemoimmunotherapy – An International Multi-institutional Study of Real World Outcomes
Presented During: Thoracic Poster Session II
Ohio State University
Columbus, OH
United States - Contact Me
Dr. Kneuertz is a thoracic surgeon at the Ohio State with a clinical focus on minimally invasive surgery of thoracic malignancies, including lung cancer, esophageal cancer, and mediastinal tumors. His research is motivated by the goal to optimize patient-centered care. Dr. Kneuertz has been a strong advocate for broadening the applications of minimally invasive techniques, and the multidisciplinary treatment of early-stage lung cancer.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
OBJECTIVE
Neoadjuvant chemoimmunotherapy trials have reported high efficacy on non-small cell lung cancer (NSCLC), but surgical data may not accurately reflect real-world outcomes. We sought to analyze outcomes of minimally invasive and open resection of NSCLC after neoadjuvant chemoimmunotherapy relative to pathologic treatment response.
METHODS
Data from 4 centers in the US and Germany were combined for all patients undergoing resection after neoadjuvant checkpoint-inhibitor and chemotherapy for locoregionally advanced NSCLC between 2000-2024. Outcomes were compared between robotic-assisted (RATS) and video-assisted thoracoscopic (VATS) versus open surgery and stratified by pathologic stage and treatment response.
RESULTS
A total of 148 patients were included, of which 114 (77.0%) underwent RATS/VATS and 34 (23.0%) open resection. RATS/VATS was more commonly used for lobectomy and segmentectomy (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<0.0001). Conversion to open (n=10) was often a result of difficult dissection due to fibrosis (70%) and occurred more frequently with VATS (30%) than RATS (4.3%). The highest rate of RATS/VATS was observed for patients with a complete pathologic response (pathCR, 45.6% vs. 14.7%, p=0.0012), whereas open resection was more often used for larger residual tumors (mean size, RATS/VATS 2.7 cm vs. open 4.8 cm, p=0.0004) and higher ypT stage (ypT3/4, RATS/VATS 11.4 % vs. open 32.4%, p=0.0004; FIGURE). Complete lymph node downstaging (ypN0/cN+) was similarly high between RATS/VATS and open resection patients (58.3% vs. 64.1%, p=0.78). Compared to open surgery, RATS/VATS was associated with shorter length of hospital stay (mean 5 days vs. 8.4 days, p<0.0001), and fewer major complications such as pneumonia (4.4% vs. 17.6%, p=0.0097), hemorrhage requiring transfusion (2.6% vs. 11.8%, p=0.028), and unexpected return to the OR (2.6% vs. 20.6%, p=0.0003). The 60-day mortality rate was 1.8% after RATS/VATS and 2.9% after open surgery.
CONCLUSIONS
This multi-institutional study demonstrates that minimally invasive resection by RATS or VATS is possible in most patients after neoadjuvant chemoimmunotherapy, especially after complete pathologic response. Open surgery is more often performed for patients with large residual tumors or those requiring extended resections. Postoperative outcomes are significantly better after minimally invasive resection.
Authors
Peter Kneuertz (1), Nestor Villamizar (2), Nasser Altorki (3), Philipp Schnorr (4), Desmond D'Souza (1), Dao Nguyen (2), Dan Jones (3), Joachim Schmidt (5), Ioana Baiu (1), Mahmoud Abdel-Rasoul (1), Robert Merritt (1)
Institutions
(1) The Ohio State University Wexner Medical Center, Columbus, OH, (2) University of Miami School of Medicine, Miami, FL, (3) Weill Cornell Medicine/NYP Hospital, New York, NY, (4) Helios Klinikum Bonn/Rhein-Sieg, Bonn, (5) University of Bonn, Bonn
Neoadjuvant chemoimmunotherapy trials have reported high efficacy on non-small cell lung cancer (NSCLC), but surgical data may not accurately reflect real-world outcomes. We sought to analyze outcomes of minimally invasive and open resection of NSCLC after neoadjuvant chemoimmunotherapy relative to pathologic treatment response.
METHODS
Data from 4 centers in the US and Germany were combined for all patients undergoing resection after neoadjuvant checkpoint-inhibitor and chemotherapy for locoregionally advanced NSCLC between 2000-2024. Outcomes were compared between robotic-assisted (RATS) and video-assisted thoracoscopic (VATS) versus open surgery and stratified by pathologic stage and treatment response.
RESULTS
A total of 148 patients were included, of which 114 (77.0%) underwent RATS/VATS and 34 (23.0%) open resection. RATS/VATS was more commonly used for lobectomy and segmentectomy (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<0.0001). Conversion to open (n=10) was often a result of difficult dissection due to fibrosis (70%) and occurred more frequently with VATS (30%) than RATS (4.3%). The highest rate of RATS/VATS was observed for patients with a complete pathologic response (pathCR, 45.6% vs. 14.7%, p=0.0012), whereas open resection was more often used for larger residual tumors (mean size, RATS/VATS 2.7 cm vs. open 4.8 cm, p=0.0004) and higher ypT stage (ypT3/4, RATS/VATS 11.4 % vs. open 32.4%, p=0.0004; FIGURE). Complete lymph node downstaging (ypN0/cN+) was similarly high between RATS/VATS and open resection patients (58.3% vs. 64.1%, p=0.78). Compared to open surgery, RATS/VATS was associated with shorter length of hospital stay (mean 5 days vs. 8.4 days, p<0.0001), and fewer major complications such as pneumonia (4.4% vs. 17.6%, p=0.0097), hemorrhage requiring transfusion (2.6% vs. 11.8%, p=0.028), and unexpected return to the OR (2.6% vs. 20.6%, p=0.0003). The 60-day mortality rate was 1.8% after RATS/VATS and 2.9% after open surgery.
CONCLUSIONS
This multi-institutional study demonstrates that minimally invasive resection by RATS or VATS is possible in most patients after neoadjuvant chemoimmunotherapy, especially after complete pathologic response. Open surgery is more often performed for patients with large residual tumors or those requiring extended resections. Postoperative outcomes are significantly better after minimally invasive resection.
Authors
Peter Kneuertz (1), Nestor Villamizar (2), Nasser Altorki (3), Philipp Schnorr (4), Desmond D'Souza (1), Dao Nguyen (2), Dan Jones (3), Joachim Schmidt (5), Ioana Baiu (1), Mahmoud Abdel-Rasoul (1), Robert Merritt (1)
Institutions
(1) The Ohio State University Wexner Medical Center, Columbus, OH, (2) University of Miami School of Medicine, Miami, FL, (3) Weill Cornell Medicine/NYP Hospital, New York, NY, (4) Helios Klinikum Bonn/Rhein-Sieg, Bonn, (5) University of Bonn, Bonn