Surgical Outcomes After Neoadjuvant Chemo-Immunotherapy for Stage III NSCLC: A Systematic Review and Meta-Analysis

Background. To comprehensively assess surgical safety, we conducted a meta-analysis on neoadjuvant chemo-immunotherapy for NSCLC. Methods. This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD42023470682). A literature search and data extraction were performed independently by two reviewers. Primary outcomes included surgical feasibility and safety. Pooled prevalence proportions with 95% confidence intervals (CIs) were calculated. A random-effects model was applied if heterogeneity was significant (I² ≥ 50% or p ≥ 0.10). Sensitivity analysis assessed robustness and publication bias was examined using funnel plots and Egger's test (p < 0.05 significant). Results. Fifteen studies were included, analyzing different immune checkpoint inhibitors with 2-3 cycles of neoadjuvant therapy. Surgery occurred 10-45 days post-treatment. The pooled surgical resection rate was 98.96% (95% CI: 98.93-98.98, I² = 0%). The conversion to thoracotomy rate was 16.49% (95% CI: 12.95-20.03, I² = 89.74%). Minimally invasive surgery was performed in 53.62% (95% CI: 49.53-57.72, I² = 95.92%). The median surgical delay was 28.53 days (95% CI: 23.66-33.41, I² = 0%). Surgical time averaged 165.27 min (95% CI: 112.32-218.22, I² = 0%), with mean blood loss of 182.0 mL (95% CI: 134.0-230.0, I² = 0%). Conclusions. Surgical intervention following neoadjuvant chemo-immunotherapy for NSCLC is feasible and safe, with a high resection rate (98.96%). Variability in minimally invasive surgery and conversion rates suggests differences in surgical approaches, while surgical time, blood loss, and delay showed consistency. These findings highlight the need for a multidisciplinary approach to optimize patient outcomes.