2024 World Conference on Lung Cancer (WCLC) - Posters-P2.07C.04 Surgical Complexity of Anatomical Lung Resections after Induction Immunotherapy for Locally Advanced or Metastatic Non-Small Cell Lung Cancer

P2.07C.04 Surgical Complexity of Anatomical Lung Resections after Induction Immunotherapy for Locally Advanced or Metastatic Non-Small Cell Lung Cancer

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This document outlines a study conducted by the Department of Thoracic Surgery at the University Hospital of Zurich on the surgical complexity of anatomical lung resections following induction immunotherapy for patients with locally advanced or oligometastatic non-small cell lung cancer (NSCLC). As immunotherapy becomes a critical component of treatment for these patients, it also presents challenges such as increased procedural complexity due to hilar and mediastinal fibrosis. The study retrospectively analyzed cases from 2017 to 2024, including 36 patients who underwent lung resection after neoadjuvant immunotherapy.<br /><br />Key findings show that a small number of procedures required conversion to thoracotomy due to extensive hilar fibrosis. Various complex surgical procedures were performed, including sleeve lobectomies, intrapericardial resections, and reconstructions of significant vascular structures like the superior vena cava. Despite the complexities, a high rate (97.2%) of R0 resections was achieved, indicating successful removal of the cancerous tissue.<br /><br />The study employed a surgical complexity score as defined by Rusch et al. to evaluate the procedures. A consistent level of lymphadenectomy was achievable, regardless of the presence of hilar fibrosis, suggesting that nodal clearance in surgeries might not be significantly compromised by fibrosis.<br /><br />The authors conclude that while current procedures in the context of neoadjuvant immunotherapy can demand higher complexity, a predictable learning curve and advancements in minimally invasive techniques might mitigate challenges in the future. They recommend systematic assessment of hilar fibrosis within clinical trials to better identify characteristics that may predict surgery complexity. This could improve preoperative planning and patient selection for neoadjuvant therapies, allowing for tailored surgical approaches.

Asset Subtitle

Raphael Werner

Meta Tag

Speaker Raphael Werner

Topic Early-Stage NSCLC

Keywords

Thoracic Surgery

Anatomical Lung Resections

Induction Immunotherapy

Non-Small Cell Lung Cancer

Surgical Complexity

Hilar Fibrosis

Neoadjuvant Therapy

R0 Resection

Lymphadenectomy

Minimally Invasive Techniques