Safety and feasibility of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in non-small cell lung cancer

Jun Zeng; Bin Yi; Ruimin Chang; Yufan Chen; Zhongjie Yu; Yang Gao

doi:10.3389/fonc.2023.1134713

Safety and feasibility of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in non-small cell lung cancer

Front Oncol. 2023 Feb 23:13:1134713. doi: 10.3389/fonc.2023.1134713. eCollection 2023.

Authors

Jun Zeng^{1

2

3

4}, Bin Yi^{1

2

3

4}, Ruimin Chang^{1

2

3

4}, Yufan Chen^{1

2

3

4}, Zhongjie Yu^{1

2

3

4}, Yang Gao^{1

2

3

4}

Affiliations

¹ Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis and Treatment, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Objectives: This study aimed to evaluate the safety and feasibility of robotic-assisted thoracic surgery (RATS) after neoadjuvant chemoimmunotherapy in NSCLC.

Methods: We retrospectively collected data for NSCLC patients who received thoracic surgery after neoadjuvant chemoimmunotherapy from May 2020 to August 2022. Surgery details, pathological response, and perioperative outcome were compared between video-assisted thoracic surgery (VATS) group and RATS group. Inverse probability of treatment weighting (IPTW) was used to equal the baseline characteristics.

Results: A total of 220 patients were divided into 78 VATS patients and 142 RATS patients. There was no 90-day mortality in either group. RATS patients demonstrated better results in conversion rate to thoracotomy (VATS vs. RATS: 28.2% vs. 7.5%, P < 0.001), number of lymph node stations harvested (5.63 ± 1.75 vs. 8.09 ± 5.73, P < 0.001), number of lymph nodes harvested (13.49 ± 9.325 vs. 20.35 ± 10.322, P < 0.001), yield pathologic-N (yp-N) assessment (yp-N0, 88.5% vs. 67.6%; yp-N1, 7.6% vs. 12.6%; yp-N2, 3.8% vs. 19.7%; P < 0.001), and visual analog scale pain score after surgery (4.41 ± 0.93 vs. 3.77 ± 1.21, P=0.002). However, there were no significant differences in pathological response evaluation for neoadjuvant chemoimmunotherapy (P = 0.493) and complication rate (P = 0.803). After IPTW-adjustment, these results remained constant.

Conclusions: RATS reduced the risk of conversion to thoracotomy, provided a better yp-N stage evaluation, and improved pain score; this suggests that RATS is safe and feasible for NSCLC patients after neoadjuvant chemoimmunotherapy.

Keywords: neoadjuvant chemoimmunotherapy; non-small-cell lung cancer; robotic-assisted thoracic surgery; safety and feasibility; video-assisted thoracic surgery.

Grants and funding

This research was supported by grants from the Project Program of National Clinical Research Center for Geriatric Disorders (2021LNJJ17); Natural Science Foundation of Hunan Province (2022JJ30925); and National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases (Lung Cancer grant number: z027002).