AUTHOR=Zeng Jun , Yi Bin , Chang Ruimin , Chen Yufan , Yu Zhongjie , Gao Yang 

TITLE=Safety and feasibility of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in non-small cell lung cancer

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1134713

DOI=10.3389/fonc.2023.1134713

ISSN=2234-943X

ABSTRACT=<sec><title>Objectives</title><p>This study aimed to evaluate the safety and feasibility of robotic-assisted thoracic surgery (RATS) after neoadjuvant chemoimmunotherapy in NSCLC.</p></sec><sec><title>Methods</title><p>We retrospectively collected data for NSCLC patients who received thoracic surgery after neoadjuvant chemoimmunotherapy from May 2020 to August 2022. Surgery details, pathological response, and perioperative outcome were compared between video-assisted thoracic surgery (VATS) group and RATS group. Inverse probability of treatment weighting (IPTW) was used to equal the baseline characteristics.</p></sec><sec><title>Results</title><p>A total of 220 patients were divided into 78 VATS patients and 142 RATS patients. There was no 90-day mortality in either group. RATS patients demonstrated better results in conversion rate to thoracotomy (VATS vs. RATS: 28.2% vs. 7.5%, <italic>P</italic> &lt; 0.001), number of lymph node stations harvested (5.63 ± 1.75 vs. 8.09 ± 5.73, <italic>P</italic> &lt; 0.001), number of lymph nodes harvested (13.49 ± 9.325 vs. 20.35 ± 10.322, <italic>P</italic> &lt; 0.001), yield pathologic-N (yp-N) assessment (yp-N0, 88.5% vs. 67.6%; yp-N1, 7.6% vs. 12.6%; yp-N2, 3.8% vs. 19.7%; <italic>P</italic> &lt; 0.001), and visual analog scale pain score after surgery (4.41 ± 0.93 vs. 3.77 ± 1.21, <italic>P</italic>=0.002). However, there were no significant differences in pathological response evaluation for neoadjuvant chemoimmunotherapy (<italic>P</italic> = 0.493) and complication rate (<italic>P</italic> = 0.803). After IPTW-adjustment, these results remained constant.</p></sec><sec><title>Conclusions</title><p>RATS reduced the risk of conversion to thoracotomy, provided a better yp-N stage evaluation, and improved pain score; this suggests that RATS is safe and feasible for NSCLC patients after neoadjuvant chemoimmunotherapy.</p></sec>