Reduction in surgical scope after neoadjuvant chemotherapy and immunotherapy for non-small cell lung cancer

Neoadjuvant chemotherapy combined with immunotherapy is a crucial treatment modality for patients with resectable non-small cell lung cancer (NSCLC). Whilst neoadjuvant chemoimmunotherapy enables tumor downstaging, the impact of reducing the surgical scope (such as from pneumonectomy to lobectomy) on safety and efficacy remains unvalidated in real-world settings. The present study aimed to use real-world data to compare the safety and long-term efficacy of several surgical methods following neoadjuvant treatment. Clinical data from 195 patients with NSCLC who were hospitalized between December 2018 and February 2022 were collected for retrospective analysis. All patients received neoadjuvant chemotherapy in combination with immunotherapy, followed by curative surgery. Patients were categorized into three groups according to the type of surgery performed as follows: Lobectomy group (n=137), reduced surgical scope group (initially assessed as requiring pneumonectomy but ultimately undergoing lobectomy or bilobectomy, including those downgraded to bilobectomy from pneumonectomy; n=42) and pneumonectomy group (n=16). Perioperative data, tumor recurrence rates and long-term survival outcomes among the three groups were compared. The results demonstrated that severe postoperative complications occurred in 29 (21.2%), 6 (14.3%) and 4 (25%) patients in each group, respectively (P=0.542). Only one patient in the pneumonectomy group died within 30 days after surgery due to severe pulmonary infection. Postoperatively, 15 (10.9%), 6 (14.3%) and 5 (31.3%) patients in each group required intensive care unit care, respectively (P=0.076). The median postoperative hospital stay (interquartile range) was 6 (5-8), 6 (6-7) and 8 (7-10) days for each group, respectively (P<0.05). Postoperative pathological evaluation revealed that 75 (54.7%), 28 (66.7%) and 6 (37.5%) patients in each group achieved a pathological complete response or major pathological response, respectively (P=0.114). During follow-up, recurrence was observed in 35 (25.5%), 6 (14.3%) and 5 (31.3%) patients in each group, respectively (P=0.454). There was no statistically significant difference in disease-free survival or overall survival among the three surgical approaches (P=0.22 and P=0.47, respectively). In conclusion, reducing the extent of surgery after neoadjuvant chemotherapy combined with immunotherapy in select patients with NSCLC appears safe and effective, warranting further investigation and prospective validation.