Table_1_Robotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy in patients with stage III non-small cell lung cancer: A real-world prospective cohort study.docx

ObjectiveStage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases. For this subset of patients, clinical management is still under debate and prognosis remains poor so far. In the present study, we aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in stage III NSCLC.
MethodsA real-world prospective cohort study was performed in a single-center setting from April 2021 to May 2022. Patients who were diagnosed with resectable or potentially resectable stage IIIA–B NSCLC and received neoadjuvant chemoimmunotherapy followed by robotic-assisted thoracic surgery were enrolled. Pathological response to neoadjuvant chemoimmunotherapy, treatment-related adverse events, and surgical outcomes of these patients were evaluated.
ResultsA total of 44 patients who underwent robotic-assisted thoracic surgery after three doses of neoadjuvant chemoimmunotherapy were included in this study. Of these, 36 of 44 (81.8%) patients had a major pathological response, and 26 (59.1%) had a pathological complete response based on pathological examination of surgical specimen. Eight patients (18.2%) suffered grade 3 treatment-related adverse events, including neutropenia (n = 4), increased aminotransferases (n = 3), anemia (n = 1), and cutaneous capillary endothelial proliferation (n = 1). Robotic-assisted thoracic surgery was performed subsequently, and R0 resection was achieved in all patients. Only two (4.5%) patients required conversion to thoracotomy. Surgical complications occurred in five (11.4%) patients, including air leak (n = 3), chylothorax (n = 2), and surgical site infection (n = 1). There was no re-surgery or postoperative mortality within 90 days.
ConclusionRobotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy showed good feasibility and safety in stage III NSCLC. It was not associated with unexpected perioperative morbidity or mortality and may be a promising therapeutic option in stage III NSCLC. These results need further confirmation by more large-scale clinical trials.

【研究背景与目的】III期非小细胞肺癌（non-small cell lung cancer, NSCLC）是一类异质性疾病，该亚组患者的临床管理仍存在争议，且目前预后不佳。本研究旨在评估新辅助化学免疫治疗（neoadjuvant chemoimmunotherapy）后行机器人辅助胸腔手术（robotic-assisted thoracic surgery）治疗III期NSCLC的可行性与安全性。

【研究方法】本研究为单中心真实世界前瞻性队列研究，纳入时间为2021年4月至2022年5月。入组患者为经确诊的可切除或潜在可切除IIIA-B期NSCLC患者，且接受新辅助化学免疫治疗后行机器人辅助胸腔手术。本研究评估了患者对新辅助化学免疫治疗的病理应答、治疗相关不良事件以及手术结局。

【研究结果】本研究共纳入44例在接受3个周期新辅助化学免疫治疗后行机器人辅助胸腔手术的患者。其中，44例患者中有36例（81.8%）达到主要病理应答，26例（59.1%）经手术标本病理检查证实达到病理完全缓解。8例患者（18.2%）发生3级治疗相关不良事件，包括中性粒细胞减少症（n=4）、转氨酶升高（n=3）、贫血（n=1）及皮肤毛细血管内皮增生（n=1）。所有患者均顺利完成机器人辅助胸腔手术，且均实现R0切除（R0 resection）；仅2例（4.5%）患者需中转开胸术。5例（11.4%）患者出现手术并发症，包括漏气（n=3）、乳糜胸（n=2）及手术部位感染（n=1）。术后90天内无再次手术或术后死亡病例发生。

【研究结论】新辅助化学免疫治疗后行机器人辅助胸腔手术治疗III期NSCLC具有良好的可行性与安全性，未出现意料之外的围手术期并发症或死亡事件，有望成为III期NSCLC的潜在治疗选择。本研究结果需通过更多大规模临床试验进一步验证。