WCLC 2025 - Posters & ePosters-EP.08.03 Surgical Outcomes in Induction and Perioperative Chemoimmunotherapy Trials: A Meta Analysis

Pdf Summary

This systematic review and meta-analysis evaluated surgical outcomes of patients with resectable non-small cell lung cancer (NSCLC) treated with neoadjuvant or perioperative immune checkpoint inhibitor (ICI)-based therapies, with or without chemotherapy. A total of 27 prospective clinical trials including 2,691 patients were analyzed to assess perioperative safety and surgical complexity after immunotherapy regimens.<br /><br />Primary outcomes measured included intraoperative and postoperative complication rates, postoperative mortality, and pneumonectomy frequency. Secondary outcomes assessed minimally invasive surgery (MIS) usage, conversion to thoracotomy, and surgical delays. Results showed low intraoperative complication rates (3%), moderate postoperative complications (27%), and low postoperative mortality (1%). Pneumonectomy was rare (0.1%), MIS was utilized in approximately 4.7% of cases, conversion to open surgery occurred in 2%, and surgical delays were under 1%.<br /><br />Meta-regression comparing immunotherapy-only (IO) versus combined chemo-immunotherapy (CTIO) revealed higher intraoperative complications and surgery omission rates with CTIO, while IO-only protocols had higher postoperative mortality. No significant differences were found between these groups in MIS use, conversion rates, or pneumonectomy frequency.<br /><br />The findings highlight new technical and perioperative challenges associated with neoadjuvant and perioperative ICI therapies in NSCLC surgery. The authors emphasize the importance of understanding these implications to optimize surgical planning and patient selection. They advocate for continued research, including real-world data and prospective registries, to refine best practices in this evolving treatment paradigm.<br /><br />Overall, neoadjuvant (chemo)-immunotherapy is generally safe with manageable surgical risks but requires careful multidisciplinary coordination to balance oncologic benefits with operative complexity.

Asset Subtitle

Pietro Bertoglio

Meta Tag

Speaker Pietro Bertoglio

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

non-small cell lung cancer

NSCLC

neoadjuvant immunotherapy

perioperative immune checkpoint inhibitors

ICI-based therapies

surgical outcomes

perioperative safety

intraoperative complications

postoperative mortality

minimally invasive surgery