Abstract 213P
Background
To comprehensively assess surgical safety of Neoadjuvant Chemo-Immunotherapy, we conducted a meta-analysis (MA).
Methods
This MA adhered to PRISMA checklist (PROSPERO registration: CRD42023470682). Primary outcomes included feasibility and safety of surgery. Effect size was all pooled prevalence proportions with 95% CIs. Homogenous test was considered significant when I2 statistic ≥50% or the p-value ≥0.10, and random-effects model was adopted. Due to high heterogeneity of single rate analysis, sensitivity analysis was conducted to exclude each selected study separately to examine robustness of pooled results. Funnel plot and Egger’s test assessed publication bias, and p
Results
15 studies were finally included (Table). MA included different immune checkpoint inhibitors (ICI).
Conclusions
This MA demonstrates feasibility and safety of surgery following neoadjuvant chemo-immunotherapy. The analysis highlights substantial heterogeneity in minimally invasive surgery and conversion rates, suggesting variability in surgical approaches. Surgical time, blood loss, and median time to surgery showed consistent results with minimal heterogeneity, affirming procedural reliability across studies. These findings underscore importance of multidisciplinary approach in optimizing outcomes in this challenging patient population.
Table 213P| Study | Lobectomy | Bilobectomy | Sleeve Lobectomy | Wedge | Pneumonectomy | Other | Exploratory Thoracotomy | Minimally Invasive | Conversion to Open | R0 | R1 | R2 | Median Time to Surgery (days) | Time (min) | Blood Loss (mL) |
| Provencio et al. | 32 | 3 | 3 | 0 | 3 | 0 | 24 | 17 | 41 | 0 | 0 | 45 | 195 | ||
| Tong et al. | 18 | 1 | 2 | 3 | 1 | 23 | 5 | 22 | 3 | 0 | 26 | 309 | |||
| Shu et al. | 19 | 4 | 0 | 0 | 3 | 3 | 14 | 12 | 26 | 26 | |||||
| Bott et al. | 15 | 1 | 1 | 1 | 2 | 14 | 7 | 20 | 18 | 228 | 100 | ||||
| Gao et al. | 18 | 5 | 1 | 0 | 13 | 2 | 29 | 10 | 36 | 0 | 1 | 36 | |||
| Yang et al. | 10 | 1 | 0 | 1 | 1 | 4 | 3 | 13 | 0 | 0 | 42 | ||||
| Shen et al. | 22 | 7 | 6 | 2 | 25 | 37 | 0 | 0 | 24 | 184 | |||||
| Jiang et al. | 18 | 4 | 7 | 0 | 2 | 0 | 9 | 1 | 24 | 4 | 3 | 34 | 158 | 200 | |
| Huang et al. | 19 | 3 | 1 | 1 | 0 | 24 | 23 | 1 | 0 | 29 | 196 | 92 | |||
| Duan et al. | 11 | 2 | 5 | 0 | 2 | 0 | 14 | 2 | 19 | 1 | 0 | 35 | 250 | 212 | |
| Chen T et al. | 8 | 1 | 3 | 0 | 0 | 9 | 3 | 12 | 0 | 0 | 28 | 140 | 200 | ||
| Chen Y et al. | 9 | 9 | 14 | 3 | 1 | 35 | 0 | 0 | 33 | 0 | |||||
| Altorki et al. | 38 | 5 | 9 | 4 | 35 | 48 | 1 | 3 | |||||||
| Forde et al. | 115 | 3 | 2 | 25 | 24 | 44 | 17 | 124 | 16 | 5 | 10 | 185 | |||
| Lee et al. | 37 | 5 | 1 | 9 | 33 | 3 | 48 | 3 | 1 | 14 | 137 | 275 |
Legal entity responsible for the study
IEO, European Institute of Oncology IRCCS.
Funding
Ministero della Salute.
Disclosure
All authors have declared no conflicts of interest.