Impact of Neoadjuvant Chemo-Immunotherapy on Lung Cancer Surgery Peri-Operative Outcomes in a Statewide Quality Collaborative

Impact of Neoadjuvant Chemo-Immunotherapy on Lung Cancer Surgery Peri-Operative Outcomes in a Statewide Quality Collaborative



Objective: Recent neoadjuvant and perioperative chemo immunotherapy (CI) regimens for non-small cell lung cancer (NSCLC) have dramatically improved oncologic outcomes for patients. Studies regarding the impact of these regimens on surgical outcomes are limited. We hypothesized that neoadjuvant CI would not have an impact on surgical outcomes at a statewide level.

Methods: A retrospective review of prospectively collected data was conducted for all Stage IB and greater patients undergoing curative intent resection for NSCLC from July 1, 2023 to June 30, 2025 at 21 centers in a statewide quality collaborative. Outcomes included operative time, surgical approach and conversion rate, post operative morbidity, length of stay (LOS), ICU admission, and 30-day mortality. Fisher's exact test was used to compare cohorts.

Results: A total of 570 patients received surgery, of which 122 (21.3%) received neoadjuvant CI. In the neoadjuvant group, 43% (52) were female. The mean age was 67 in both cohorts. The most common resection performed was lobectomy, 113 (92.62%), followed by pneumonectomy 8 (6.6%), with the remainder undergoing wedge resection. Those who received CI were more likely to undergo an open operation, 32.79% (40) vs 17.1% (77) (p=0.0002), had a higher conversion to open rate 13.9% (17) vs 7.3% (33) (p < 0.02), and had longer mean operative times, 244 mins vs 202 mins (p <0.0001), Table. Transfusion, ICU and reoperation rates were similar between cohorts. Rates of major post operative morbidity were similar between groups, 8.2% (10) vs 7.4% (33) (p = 0.14) including prolonged air leak 15.6% (19) vs 12.7% (57) (p = 0.08) and atrial arrhythmia 13.9% (17) vs 8.2% (37) (p=0.06). While readmission rates were similar 10.9% (13) vs 9.2% (41) (p=0.11), the neoadjuvant CI cohort had a longer mean LOS 5.5 days vs 4.8 (p = 0.002), and higher 30-day mortality, 4.9% (6) vs 0.89% (4) (p = 0.007).

Conclusion: Neoadjuvant CI in resectable NSCLC is associated with more open surgery, more conversions, and longer operative times. While major post operative morbidity is similar to those not receiving neoadjuvant CI, LOS is slightly longer and perioperative mortality is worse.

Andrew Popoff (1), Chang He (2), Jenny Bui (3), Mary Elise Hollenbeck (4), Thomas Watson (5), Melanie Edwards (6), Rishindra Reddy (7), (1) Henry Ford Health, Royal Oak, MI, (2) Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, (3) Henry Ford Health, MI, (4) Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Pinckney, MI, (5) Corewell Health, Royal Oak, MI, (6) St. Joseph Mercy Ann Arbor, Ypsilanti, MI, (7) University of Michigan Health System, Ann Arbor, MI