Perioperative outcomes of video-assisted thoracoscopic surgery versus thoracotomy after neoadjuvant therapy for non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QING Yang ^1,2 , TENG Meixin ^1,2 , YAO Wangchao ^2,3 , ZHANG Jing ^2,3 ,  ZHANG Peng ^1,2

1. Medical College of Shihezi University, Shihezi, 832002, Xinjiang, P. R. China;
2. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, 200092, P. R. China;
3. Central Laboratory, Shanghai Pulmonary Hospital, Shanghai, 200092, P. R. China;

Corresponding author：

ZHANG Peng, Email: zhangpeng1121@tongji.edu.cn

Keywords：

Neoadjuvant therapy; non-small cell lung cancer; video-assisted thoracoscopic surgery; thoracotomy

DOI：

10.7507/1007-4848.202401081

Video：

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Objective To investigate the perioperative differences between video-assisted thoracoscopic surgery (VATS) and thoracotomy after neoadjuvant therapy in patients with non-small cell lung cancer (NSCLC). Methods Clinical data of NSCLC patients who underwent VATS or thoracotomy after neoadjuvant therapy at Shanghai Pulmonary Hospital from June 2020 to May 2022 were retrospectively collected. Perioperative outcomes were compared between the two groups. Results A total of 260 patients were enrolled, 184 (70.8%) patients underwent VATS and 76 (29.2%) patients underwent thoracotomy. After propensity matching, there were 113 (62.4%) patients in the VATS group and 68 (37.6%) patients in the thoracotomy group. VATS had similar lymph node dissection ability and postoperative complication rate with thoracotomy (P>0.05), with the advantage of having shorter operative time (146.00 min vs. 165.00 min, P=0.006), less intraoperative blood loss (50.00 mL vs. 100.00 mL, P<0.001), lower intraoperative blood transfusion rate (0.0% vs. 7.4%, P=0.003), less 3-day postoperative drainage (250.00 mL vs. 350.00 mL, P=0.011; 180.00 mL vs. 250.00 mL, P=0.002; 150.00 mL vs. 235.00 mL, P<0.001), and shorter postoperative drainage time (9.34 d vs. 13.84 d, P<0.001) and postoperative hospitalization time (6.19 d vs. 7.94 d, P=0.006). Conclusion VATS after neoadjuvant therapy for NSCLC is safer than thoracotomy and results in better postoperative recovery.

Citation： QING Yang, TENG Meixin, YAO Wangchao, ZHANG Jing, ZHANG Peng. Perioperative outcomes of video-assisted thoracoscopic surgery versus thoracotomy after neoadjuvant therapy for non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(4): 488-499. doi: 10.7507/1007-4848.202401081 Copy

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2.	NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer: A systematic review and meta-analysis of individual participant data. Lancet, 2014, 383(9928): 1561-1571.
3.	Forde PM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022, 386(21): 1973-1985.
4.	Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus chemotherapy in NSCLC with EGFR exon 20 insertions. N Engl J Med, 2023, 389(22): 2039-2051.
5.	Zhou C, Solomon B, Loong HH, et al. First-line selpercatinib or chemotherapy and pembrolizumab in RET fusion-positive NSCLC. N Engl J Med, 2023, 389(20): 1839-1850.
6.	Bott MJ, Yang SC, Park BJ, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(1): 269-276.
7.	Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: A randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
8.	Manerikar A, Querrey M, Cerier E, et al. Comparative effectiveness of surgical approaches for lung cancer. J Surg Res, 2021, 263: 274-284.
9.	Lee PC, Kamel M, Nasar A, et al. Lobectomy for non-small cell lung cancer by video-assisted thoracic surgery: Effects of cumulative institutional experience on adequacy of lymphadenectomy. Ann Thorac Surg, 2016, 101(3): 1116-1122.
10.	Xu J, Ni H, Wu Y, et al. Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: A multi-center propensity score-matched analysis. Transl Lung Cancer Res, 2021, 10(1): 402-414.
11.	Yang CJ, Nwosu A, Mayne NR, et al. A minimally invasive approach to lobectomy after induction therapy does not compromise survival. Ann Thorac Surg, 2020, 109(5): 1503-1511.
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13.	Pu CY, Rodwin S, Nelson B, et al. Approach to resectable N1 non-small cell lung cancer: An analysis of the National Cancer Database. J Surg Res, 2021, 259: 145-153.
14.	Zhang B, Xiao Q, Xiao H, et al. Perioperative outcomes of video-assisted thoracoscopic surgery versus open thoracotomy after neoadjuvant chemoimmunotherapy in resectable NSCLC. Front Oncol, 2022, 12: 858189.
15.	Dell'Amore A, Lomangino I, Tamburini N, et al. Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: A multicenter propensity-matched study. Surg Endosc, 2022, 36(2): 1466-1475.
16.	Pataer A, Kalhor N, Correa A M, et al. Histopathologic response criteria predict survival of patients with resected lung cancer after neoadjuvant chemotherapy. J Thorac Oncol, 2012, 7(5): 825-832.
17.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2023版). 中华医学杂志, 2023, 103(27): 2037-2074.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition). Natl Med J China, 2023, 103(27): 2037-2074.
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19.	Kamel MK, Nasar A, Stiles BM, et al. Video-assisted thoracoscopic lobectomy is the preferred approach following induction chemotherapy. J Laparoendosc Adv Surg Tech A, 2017, 27(5): 495-500.
20.	Lv C, Fang W, Wu N, et al. Osimertinib as neoadjuvant therapy in patients with EGFR-mutant resectable stage Ⅱ-ⅢB lung adenocarcinoma (NEOS): A multicenter, single-arm, open-label phase 2b trial. Lung Cancer, 2023, 178: 151-156.
21.	Gong R, Hu H, Chen H. Neoadjuvant gefitinib for stage Ⅱ-ⅢA NSCLC with activating EGFR mutation (NCT01833572): An open-label, single-arm, phase Ⅱ study. J Clin Oncol, 2016, 34(15_suppl): e20026.
22.	Bian D, Sun L, Hu J, et al. Neoadjuvant afatinib for stage Ⅲ EGFR-mutant non-small cell lung cancer: A phaseⅡstudy. Nat Commun, 2023, 14(1): 4655.
23.	张楠, 陈星, 郭立人, 等. 局部晚期非小细胞肺癌新辅助靶向治疗后手术2例报告. 中国微创外科杂志, 2022, 22(4): 359-362.Zhang N, Chen X, Guo LR, et al. Surgery following neoadjuvant targeted therapy for locally advanced non-small cell lung cancer: Two cases report. Chin J Min Inv Surg, 2022, 22(4): 359-362.
24.	王峥, 王猛, 孙大强. 新辅助免疫治疗联合化疗后袖式切除术的安全性研究. 中国胸心血管外科临床杂志, 2024, 31(12): 1775-1780.Wang Z, Wang M, Sun DQ. Efficacy of sleeve lobectomy after neoadjuvant chemoimmunotherapy in lung cancer: A retrospective cohort study. Chin Clin Thorac Cardiovasc Surg, 2024, 31(12): 1775-1780.
25.	Sedighim S, Frank MI, Heutlinger O, et al. A systematic review of short-term outcomes of minimally invasive thoracoscopic surgery for lung cancer after neoadjuvant systemic therapy. Cancers (Basel), 2023, 15(15): 3908.
26.	O'Donnell JS, Hoefsmit EP, Smyth MJ, et al. The promise of neoadjuvant immunotherapy and surgery for cancer treatment. Clin Cancer Res, 2019, 25(19): 5743-5751.
27.	Toker A, Özyurtkan M O, Kaba E. Nodal upstaging: Effects of instrumentation and three-dimensional view in clinical stage Ⅰ lung cancer. J Vis Surg, 2017, 3: 76.

1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2. NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer: A systematic review and meta-analysis of individual participant data. Lancet, 2014, 383(9928): 1561-1571.
3. Forde PM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022, 386(21): 1973-1985.
4. Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus chemotherapy in NSCLC with EGFR exon 20 insertions. N Engl J Med, 2023, 389(22): 2039-2051.
5. Zhou C, Solomon B, Loong HH, et al. First-line selpercatinib or chemotherapy and pembrolizumab in RET fusion-positive NSCLC. N Engl J Med, 2023, 389(20): 1839-1850.
6. Bott MJ, Yang SC, Park BJ, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(1): 269-276.
7. Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: A randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
8. Manerikar A, Querrey M, Cerier E, et al. Comparative effectiveness of surgical approaches for lung cancer. J Surg Res, 2021, 263: 274-284.
9. Lee PC, Kamel M, Nasar A, et al. Lobectomy for non-small cell lung cancer by video-assisted thoracic surgery: Effects of cumulative institutional experience on adequacy of lymphadenectomy. Ann Thorac Surg, 2016, 101(3): 1116-1122.
10. Xu J, Ni H, Wu Y, et al. Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: A multi-center propensity score-matched analysis. Transl Lung Cancer Res, 2021, 10(1): 402-414.
11. Yang CJ, Nwosu A, Mayne NR, et al. A minimally invasive approach to lobectomy after induction therapy does not compromise survival. Ann Thorac Surg, 2020, 109(5): 1503-1511.
12. Boffa D, Fernandez FG, Kim S, et al. Surgically managed clinical stage ⅢA clinical N2 lung cancer in the Society of Thoracic Surgeons database. Ann Thorac Surg, 2017, 104(2): 395-403.
13. Pu CY, Rodwin S, Nelson B, et al. Approach to resectable N1 non-small cell lung cancer: An analysis of the National Cancer Database. J Surg Res, 2021, 259: 145-153.
14. Zhang B, Xiao Q, Xiao H, et al. Perioperative outcomes of video-assisted thoracoscopic surgery versus open thoracotomy after neoadjuvant chemoimmunotherapy in resectable NSCLC. Front Oncol, 2022, 12: 858189.
15. Dell'Amore A, Lomangino I, Tamburini N, et al. Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: A multicenter propensity-matched study. Surg Endosc, 2022, 36(2): 1466-1475.
16. Pataer A, Kalhor N, Correa A M, et al. Histopathologic response criteria predict survival of patients with resected lung cancer after neoadjuvant chemotherapy. J Thorac Oncol, 2012, 7(5): 825-832.
17. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2023版). 中华医学杂志, 2023, 103(27): 2037-2074.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition). Natl Med J China, 2023, 103(27): 2037-2074.
18. Hanna J M, Berry MF, D'Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis, 2013, 5 (Suppl 3): S182-S189.
19. Kamel MK, Nasar A, Stiles BM, et al. Video-assisted thoracoscopic lobectomy is the preferred approach following induction chemotherapy. J Laparoendosc Adv Surg Tech A, 2017, 27(5): 495-500.
20. Lv C, Fang W, Wu N, et al. Osimertinib as neoadjuvant therapy in patients with EGFR-mutant resectable stage Ⅱ-ⅢB lung adenocarcinoma (NEOS): A multicenter, single-arm, open-label phase 2b trial. Lung Cancer, 2023, 178: 151-156.
21. Gong R, Hu H, Chen H. Neoadjuvant gefitinib for stage Ⅱ-ⅢA NSCLC with activating EGFR mutation (NCT01833572): An open-label, single-arm, phase Ⅱ study. J Clin Oncol, 2016, 34(15_suppl): e20026.
22. Bian D, Sun L, Hu J, et al. Neoadjuvant afatinib for stage Ⅲ EGFR-mutant non-small cell lung cancer: A phaseⅡstudy. Nat Commun, 2023, 14(1): 4655.
23. 张楠, 陈星, 郭立人, 等. 局部晚期非小细胞肺癌新辅助靶向治疗后手术2例报告. 中国微创外科杂志, 2022, 22(4): 359-362.Zhang N, Chen X, Guo LR, et al. Surgery following neoadjuvant targeted therapy for locally advanced non-small cell lung cancer: Two cases report. Chin J Min Inv Surg, 2022, 22(4): 359-362.
24. 王峥, 王猛, 孙大强. 新辅助免疫治疗联合化疗后袖式切除术的安全性研究. 中国胸心血管外科临床杂志, 2024, 31(12): 1775-1780.Wang Z, Wang M, Sun DQ. Efficacy of sleeve lobectomy after neoadjuvant chemoimmunotherapy in lung cancer: A retrospective cohort study. Chin Clin Thorac Cardiovasc Surg, 2024, 31(12): 1775-1780.
25. Sedighim S, Frank MI, Heutlinger O, et al. A systematic review of short-term outcomes of minimally invasive thoracoscopic surgery for lung cancer after neoadjuvant systemic therapy. Cancers (Basel), 2023, 15(15): 3908.
26. O'Donnell JS, Hoefsmit EP, Smyth MJ, et al. The promise of neoadjuvant immunotherapy and surgery for cancer treatment. Clin Cancer Res, 2019, 25(19): 5743-5751.
27. Toker A, Özyurtkan M O, Kaba E. Nodal upstaging: Effects of instrumentation and three-dimensional view in clinical stage Ⅰ lung cancer. J Vis Surg, 2017, 3: 76.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative outcomes of video-assisted thoracoscopic surgery versus thoracotomy after neoadjuvant therapy for non-small cell lung cancer: A retrospective cohort study

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