BACKGROUND: Phase II and III trials have shown excellent pathologic response and long-term survival following neoadjuvant(NAT) chemo-immunotherapy(CI) for patients undergoing surgery for early-stage non-small cell lung cancer (NSCLC). However, these trials consistently show a high rate of open surgery, and high (10-20%) conversion rates of patients undergoing video-assisted thoracic surgery. Real world outcomes of minimally invasive lobectomy after NAT CI are currently lacking. We present our first consecutive cohort of patients treated with the Checkmate 816 NAT protocol followed by robotic-assisted thoracoscopic surgery(RATS).METHODS: We reviewed our Institutional STS Quality Database of patients undergoing lobectomy between 08/2022-08/2023. We included patients, with clinical stage IB-IIIa NSCLC who were subjected to molecular testing at the time of diagnosis to confirm the absence of targetable mutations. Patients received NAT CI, consisting of Nivolumab and Carboplatin-Pemetrexate. We collected baseline characteristics such as age, gender, tumor histology, and clinical stage. Outcomes examined were the duration of hospitalization, the rate of conversion to open surgery, and STS defined complications. Furthermore, we assessed the pathologic response following NAT CI based on the patients' PD-L1 status.RESULTS: Our study included a total of 22 NSCLC patients. The median age was 65 years(IQR: 60-72). The majority were male (55%), clinically staged IIIa (64%), and had tumors with non-squamous histology (68% adenocarcinoma 27% squamous cell carcinoma and 5% others). All patients completed a RATS lobectomy with zero conversions to thoracotomy. The median length of stay was 3(IQR: 3-5) days. The overall complication rate was 32%, with atrial fibrillation being the most common and air leaks >5 days being the least common (5%). All patients had a complete R0 resection. 68% had a major pathologic response (MPR) and 32% had a pathological complete response (pCR). MPR and cPR were higher for patients with tumor PD-L1 expression> 1% (Figure). Lymph node downstaging was observed in 61% of patients.CONCLUSIONS:RATS may be performed safely with minimal risk for conversion following NAT CI. A rapid postoperative recovery from RATS lobectomy after NAT may be observed similarly to patients treated with upfront surgery with higher MPR than expected.
