Robotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy in patients with stage III non-small cell lung cancer: A real-world prospective cohort study

Yang Gao; Juan Jiang; Desheng Xiao; Yanwu Zhou; Yufan Chen; Huaping Yang; Lijing Wang; Jun Zeng; Baimei He; Ruoxi He; Min Li; Zhaoqian Liu

doi:10.3389/fonc.2022.969545

Robotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy in patients with stage III non-small cell lung cancer: A real-world prospective cohort study

Front Oncol. 2022 Aug 4:12:969545. doi: 10.3389/fonc.2022.969545. eCollection 2022.

Authors

Yang Gao^{1

2

3

4}, Juan Jiang^{4

5

6

7}, Desheng Xiao⁸, Yanwu Zhou¹, Yufan Chen¹, Huaping Yang^{4

5

6

7}, Lijing Wang^{9

10}, Jun Zeng¹, Baimei He^{9

10}, Ruoxi He^{4

5

6

7}, Min Li^{4

5

6

7

10}, Zhaoqian Liu^{2

10}

Affiliations

¹ Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China.
² Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, China.
³ Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, China.
⁴ Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.
⁶ Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
⁷ Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
⁸ Department of Pathology, Xiangya Hospital, School of Basic Medicine, Central South University, Changsha, China.
⁹ Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁰ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Objective: Stage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases. For this subset of patients, clinical management is still under debate and prognosis remains poor so far. In the present study, we aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in stage III NSCLC.

Methods: A real-world prospective cohort study was performed in a single-center setting from April 2021 to May 2022. Patients who were diagnosed with resectable or potentially resectable stage IIIA-B NSCLC and received neoadjuvant chemoimmunotherapy followed by robotic-assisted thoracic surgery were enrolled. Pathological response to neoadjuvant chemoimmunotherapy, treatment-related adverse events, and surgical outcomes of these patients were evaluated.

Results: A total of 44 patients who underwent robotic-assisted thoracic surgery after three doses of neoadjuvant chemoimmunotherapy were included in this study. Of these, 36 of 44 (81.8%) patients had a major pathological response, and 26 (59.1%) had a pathological complete response based on pathological examination of surgical specimen. Eight patients (18.2%) suffered grade 3 treatment-related adverse events, including neutropenia (n = 4), increased aminotransferases (n = 3), anemia (n = 1), and cutaneous capillary endothelial proliferation (n = 1). Robotic-assisted thoracic surgery was performed subsequently, and R0 resection was achieved in all patients. Only two (4.5%) patients required conversion to thoracotomy. Surgical complications occurred in five (11.4%) patients, including air leak (n = 3), chylothorax (n = 2), and surgical site infection (n = 1). There was no re-surgery or postoperative mortality within 90 days.

Conclusion: Robotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy showed good feasibility and safety in stage III NSCLC. It was not associated with unexpected perioperative morbidity or mortality and may be a promising therapeutic option in stage III NSCLC. These results need further confirmation by more large-scale clinical trials.

Keywords: chemoimmunotherapy; neoadjuvant immunotherapy; neoadjuvant therapy; non-small cell lung cancer; robotic-assisted thoracic surgery.