Thoracic: Lung Cancer
Neoadjuvant therapy does not increase postoperative morbidity of sleeve lobectomy in locally advanced non–small cell lung cancer

https://doi.org/10.1016/j.jtcvs.2023.03.016Get rights and content
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Abstract

Objectives

To evaluate the feasibility and safety of sleeve lobectomy after neoadjuvant therapy by assessing the postoperative morbidity.

Methods

Patients who underwent sleeve lobectomy for non–small cell lung cancer (NSCLC) were retrospectively analyzed from January 2018 to December 2021. A total of 613 patients were enrolled, including 124 patients who received previous neoadjuvant therapy and 489 patients who did not. Propensity score matching was adopted to create a balanced cohort consisting of 97 paired cases. Patient demographics and perioperative outcomes were compared between the 2 groups, and logistic regression analysis was used to identify risk factors for postoperative complications.

Results

In the entire cohort, univariable logistic regression analysis showed that smoking history (odds ratio [OR], 1.501; 95% confidence interval [CI], 1.011-2.229, P = .044), open thoracotomy (OR, 1.748; 95% CI, 1.178-2.593, P = .006), and operation time more than 150 minutes (OR, 1.548; 95% CI, 1.029-2.328, P = .036) were risk factors for postoperative complications, and multivariable logistic regression analysis showed open thoracotomy was an independent risk factor (OR, 1.765; 95% CI, 1.178-2.643, P = .006). In the balanced cohort, the neoadjuvant group had a lower proportion of double-sleeve resections (3.1% vs 11.3%, P = .035) and longer postoperative chest tube drainage (6.67 ± 3.81 vs 5.13 ± 3.74 days, P < .001). However, no significant differences were observed in postoperative morbidity between the 2 groups (25.8% vs 24.7%, P = .869). The complete pathologic response of chemoimmunotherapy was significantly superior to chemotherapy alone (28.2% vs 4.1%, P < .001), and no significant differences were noted in postoperative morbidity in different neoadjuvant therapy modalities.

Conclusions

After neoadjuvant therapy, sleeve lobectomy can be safely performed with no increased postoperative morbidity.

Key Words

sleeve lobectomy
neoadjuvant therapy
NSCLC
postoperative complications

Abbreviations and Acronyms

CT
computed tomography
NSCLC
non–small cell lung cancer
OR
odds ratio
PSM
propensity score matching
VATS
video-assisted thoracoscopic surgery

Cited by (0)

This study was supported by Shanghai Pulmonary Hospital Fund (No. fkly20018), China.

Drs X. Li and Q. Li contributed equally to this article.