Efficacy and Surgical Complexity of Neoadjuvant Chemo-Immunotherapy for Locally Advanced Non- Small Cell Lung Cancer

Nozomu Motono, Masahito Ishikawa, Shun Iwai, Yoshihito Iijima and Hidetaka Uramoto

Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan

^*Correspondance to: Nozomu Motono 

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Abstract:

Introduction: The efficacy of immune checkpoint inhibitors (ICIs) in combination with platinumbased chemotherapy before surgery in patients with locally advanced resectable non-small cell lung cancer has been shown. However, cases of unresectability due to progression of disease or adverse events have been reported, as well as cases of conversion to open thoracotomy, often due to hilar inflammation and fibrosis. Methods: Patients with locally advanced non-small cell lung cancer who received preoperative therapy between 2013 to 2025 were retrospectively studied. We analyzed the course of preoperative therapy, operative findings, and pathological responses. Results: There was no significant difference in the proportion of open thoracotomy (62.5% vs 60.8%) or postoperative complications (50% vs 42%) between the chemo-immunotherapy (CIT) group and the non-ICIs group, whereas adhesion or fibrosis around lesions tended to be higher in the CIT group (62.5% vs 43.4%). In patients with neoadjuvant therapy, a major pathological response was significantly more frequent in squamous cell carcinoma (SCC) than in non-SCC (29% vs 0%), and in SCC treated by chemoradiotherapy (40% vs 0%). Furthermore, the frequency of a complete pathological response tended to be higher in SCC (36% vs 12%) and in SCC treated by CIT (50% vs 0%). Conclusion: Although CIT might increase the surgical complexity, its surgical outcomes are similar to those in patients without ICIs. CIT and chemoradiotherapy may have a therapeutic effect in patients with locally advanced SCC, whereas CIT might not be appropriate for patients with locally advanced non-SCC. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.

Keywords:

Neoadjuvant therapy; Chemo-immunotherapy; Surgical complexity; Non-small cell lung cancer

Cite the Article:

Motono N, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Efficacy and Surgical Complexity of Neoadjuvant Chemo- Immunotherapy for Locally Advanced Non-Small Cell Lung Cancer. World J Surg Surgical Res. 2026; 9: 1622..