Abstract 219P
Background
Most phase III trials evaluating immune checkpoint blockade (ICB) for resectable non-small cell lung cancer (rNSCLC) have reported limited surgical data and did not classify complications using standardized thoracic surgical morbidity criteria. This study aims to analyze the surgical outcomes and complication profile of neoadjuvant chemotherapy combined with ICB in a real-world setting.
Methods
This single-center cohort study included patients who underwent radical surgery for rNSCLC after neoadjuvant chemo-immunotherapy between 2022 and April 2024. The primary endpoint was the rate of major complications (Grade 3 or higher). Secondary endpoints included surgical outcomes, pathological complete response (pCR), and major pathological response (MPR) rates.
Results
A total of 44 patients were included, with a median age of 63 years (range: 42–74). A history of smoking was reported in 87% of patients, and 13 patients had squamous cell histology. Clinical stage IIIA was the most common (63%). All patients received 3–4 cycles of chemo-immunotherapy without treatment-related Grade III/IV toxicities, and R0 resection was achieved in all cases. Surgical procedures included 30 lobectomies, 2 bilobectomies, and 12 extended lobectomies (3 bronchial sleeves, 6 en bloc with segment, 1 with diaphragm, and 2 with chest wall resections). The median operative time was 165 minutes (range: 110–365). Seventeen surgeries (38%) were performed robotically, with only one converted to open surgery due to intraoperative bleeding. The median hospital stay was 7 days (range: 4–30), and the median daily drainage output was 195 mL (range: 70–500). No 30-day or 90-day mortality was reported. Postoperative complications occurred in 37.2% of cases (any grade), with Grade III/IV complications in 7.1%. The most common complication was prolonged air leaks (23%). Seven patients required reoperation for complications. Pathological examination revealed a pCR in 19 patients (43.2%).
Conclusions
Neoadjuvant chemo-immunotherapy followed by lung resections seems to be safe and feasible in resectable NSCLC with high rate of pCR in a real-world setting.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.