Early outcomes of minimally invasive surgery versus thoracotomy for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a multi-center propensity score- matched study

Background: Neoadjuvant immunochemotherapy has revolutionized the treatment of non-small lung cancer (NSCLC) but may notably escalate the surgery’s intricacy. Consequently, the sufficiency of minimally invasive surgery (MIS) remains controversial. This study aims to assess the safety and feasibility of MIS for NSCLC patients after induction immunochemotherapy. Methods NSCLC patients with neoadjuvant immunochemotherapy who underwent MIS or open lobectomy at six institutions from 2019 to 2023 were retrospectively identified. Propensity-score matching (PSM) was applied to balance baseline clinical characteristics. Results A total of 186 cases were included, and PSM led to 84 patients in MIS and OPEN groups. The baseline clinical characteristics and induction-related adverse events were comparable between the two groups (all P  > 0.050). 11.9% of MIS converted to thoracotomy. By comparison, the MIS group was associated with reduced blood loss (100 [100–125] vs. 100 [100–200] mL, P  = 0.011), shortened chest tube duration (5 [4–7] vs. 6 [5–8] days, P  = 0.007), and decreased assessed lymph nodes (LNs; 12 [9–15] vs. 14 [11–20], P  = 0.007) compared with the OPEN group. The two groups had no difference in the other surgical and pathological outcomes (all P  > 0.050). Finally, MIS reduced postoperative complications compared with thoracotomy (23.8% vs. 39.3%, P  = 0.031) Conclusion MIS is safe and feasible for NSCLC patients with neoadjuvant immunochemotherapy, with the advantages of lower blood loss, faster recoveries, and fewer postoperative complications and the disadvantage of LN assessment compared with thoracotomy.