Analysis of the safety and feasibility of sleeve resection under UniVATS after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer.

Abstract

Objective: To investigate the safety and feasibility of sleeve resection under Uni-VATS following neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer(NSCLC).

Methods: We analyzed 10 cIIB-IIIB NSCLC patients who underwent sleeve lung resection under single-port thoracoscopy from December 2022 to August 2023 after receiving platinum-based chemotherapy combined with albumin paclitaxel and programmed cell death protein-1 (PD-1) inhibitor drugs. Perioperative clinical data, side effects during neoadjuvant therapy, operation time, intraoperative blood loss, conversion rate to open thoracotomy, postoperative duration of chest tube placement, postoperative drainage volume, postoperative complications, and tumor outcomes were recorded.

Results: This study included 10 patients. The preoperative clinical staging distribution was as follows: Stage IIB, 1 case; Stage IIIA, 5 cases; and Stage IIIB, 4 cases. Imaging evaluation after neoadjuvant therapy revealed that none of the patients achieved complete remission, whereas partial remission and stable disease were observed in 7 cases and 3 cases, respectively. All patients successfully underwent surgery, of which 2 patients required conversion to open thoracotomy (conversion rate, 20%) and 8 patients underwent single-port thoracoscopic minimally invasive surgery. Notably, 2 patients underwent sleeve resection of the right upper lobe, 2 patients underwent sleeve resection of the right middle and lower lobes, 2 patients underwent sleeve resection of the left upper lobe, and 4 patients underwent sleeve resection of the left lower lobe. The average operation time was 236 ± 87.7 min, the average intraoperative blood loss was 168 ± 62.5 mL, the average duration of chest tube placement was 5 days, the average total drainage volume was 1012 ± 464 mL, and the average hospitalization duration was 7 days. One patient developed encapsulated pleural effusion after surgery and underwent computed tomography (CT)-guided puncture drainage. At the 3-month and 6-month follow-up visits, no patient reported any particular discomfort, and chest radiography and CT revealed no abnormalities or signs of tumor recurrence.

Conclusion: Sleeve resection after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type NSCLC under single-port thoracoscopy is safe and feasible and provides short-term postoperative benefits for patients.