Surgery Challenges and Postoperative Complications of Lung Cancer after Neoadjuvant Immunotherapy: A Cohort Study

Abstract

Abstract Background In China, real-world data on surgical challenges and postoperative complications after neoadjuvant immunotherapy of lung cancer is limited. Methods Patients were retrospectively enrolled from January 2018 to January 2023, whose clinical and pathological characters were subsequently analyzed. Surgical difficulty was categorized into a binary classification, namely challenging or routine. Postoperative complications were graded using Clavien-Dindo grades. Logistic regression was used to identify risk factors affecting the duration of surgery and postoperative complications greater than Clavien-Dindo grade 2. Results In total, 261 patients were included. Of these, phase Ⅲ patients accounted for 62.5% (163/261) at initial diagnosis, with 25.3% (66/261) at phase ⅢB. Central-type NSCLC accounts for 61.7% (161/261). One hundred forty patients underwent video-assisted thoracoscopic surgery, and lobectomy accounts for 53.3% (139/261) of patients. Challenging surgeries account for 43.7%. The postoperative complications rate of 261 patients was only 22.2%. Smoking history (OR = 9.96, CI:1.15–86.01, P = 0.03), chemoimmunotherapy (OR = 2.89, CI:1.22–6.86, P = 0.02), and conversion to open surgery (OR = 11.3, CI:1.38–92.9, P = 0.02) were identified as independent risk factors for challenging surgeries, while pneumonectomy (OR = 0.36, CI:0.15–0.86, P = 0.02) a protective factor. Meanwhile, pneumonectomy (OR = 7.51, CI:2.40-23.51, P < 0.01) and challenging surgeries (OR = 5.53, CI:1.50-20.62, P = 0.01) were found to be risk factors for postoperative complications greater than Clavien-Dindo grade 2. Conclusions Compared to immunotherapy alone or in combination with apatinib, neoadjuvant immunotherapy could increase the difficulty of surgery while the incidence of postoperative complications remains acceptable.