Experience of Induction Immunotherapy Video-Assisted Thoracoscopic Surgery/Robotic-Assisted Thoracoscopic Surgery for Advanced Lung Cancer

Abstract

Minimally invasive surgery (MIS) via video-assisted or robotic-assisted techniques has become the standard of care for stage I non-small cell lung cancer (NSCLC) due to improvements in short-term outcomes.Evidence supporting the use of MIS for locally advanced NSCLC is less clear.Successful MIS in locally advanced disease is complicated by the extent of disease, nodal involvement, and hilar fibrosis from neoadjuvant treatment.The inability to successfully complete MIS anatomic resection is cited as a reason by surgeons to defer induction therapy, despite the growing evidence for the benefit of neoadjuvant and perioperative immune checkpoint inhibition for locally advanced NSCLC.Evidence suggests that fibrosis related to immunotherapy is not increased compared to other systemic therapies.In experienced hands, 70%-80% of resections following immunotherapy can be completed using MIS techniques.Involved N1 nodes and radiographic response to treatment are markers for increased technical challenge.MIS for locally advanced disease and in the post-induction setting requires nuanced patient discussion, communication with the anesthesia team, careful operative technique, and a willingness to pivot to an open approach rather than compromise R0 resection or safety.Session 10