Thoracic surgical challenges after neoadjuvant immunotherapy for non-small cell lung cancer: a narrative review

Abstract

Background and Objective: Lung cancer is the leading cause of cancer-related death, with an increasing incidence in both sexes and all ages. Locally advanced non-small cell lung cancer (NSCLC) should be considered as a systemic disease that requires a multimodal approach. Neoadjuvant regimens including chemotherapy, radiotherapy and immunotherapy are widely available options in several centers. The impact of neoadjuvant immunotherapy on surgery is a hot topic for thoracic surgeon because of the technical feasibility of lung resection, especially with a minimally invasive approach, after treatment. The aim of this review is to describe the peri-operative outcomes in patients who underwent neoadjuvant immunotherapy treatment.Methods: We performed a literature research in PubMed, Medline, Embase, CENTRAL and CINAHL databases. Papers reporting surgical-related complications after neoadjuvant immunotherapy were included.Following terms were used: NSCLC, lung resection, neoadjuvant immunotherapy, survival, feasibility of lung surgery after neoadjuvant treatment, lung surgery after immunotherapy. Only papers written in English were included.