Background:Neoadjuvant therapy, particularly the combination of chemotherapy and immunotherapy, has become standard in treating locally advanced non-small cell lung cancer (NSCLC). While this approach improves pathologic responses, its effect on postoperative outcomes following robotic-assisted thoracic surgery (RATS) is not fully characterized.Objective:This study aimed to evaluate the impact of neoadjuvant therapy on postoperative outcomes in patients undergoing RATS for NSCLC, focusing on operative time, conversion rates to open surgery, and postoperative complications.Methods:A retrospective cohort analysis was performed on patients who underwent RATS for NSCLC between February 2019 and August 2024. Propensity score matching was utilized to balance preoperative characteristics between the groups. The primary outcomes compared were operative time, conversion rates to open surgery, and postoperative complications, with statistical significance defined asp< 0.05.Results:A total of 253 patients were included in the analysis, of whom 23 received neoadjuvant therapy (either chemotherapy or chemoimmunotherapy) and 230 did not. The neoadjuvant group had significantly longer operative times (250 min vs. 221 min,p= 0.001) but there were no significant differences in conversion rates to open surgery (8.7% vs. 3.9%,p= 0.5). However, the neoadjuvant group showed a higher incidence of prolonged air leaks (>5 days) (39.13% vs. 35.21%,p< 0.001). Other parameters, such as hospital stay and chest drainage duration, showed no statistically significant differences between the groups (p= 0.860 andp= 0.760, respectively).Conclusions:These findings support the feasibility of robotic-assisted thoracic surgery following neoadjuvant therapy in NSCLC, suggesting that this approach may be safely integrated into clinical practice for selected patients. Further studies are needed to define patient selection criteria and optimize postoperative management, potentially guiding personalized treatment strategies in complex cases.
背景：新辅助治疗，特别是化疗联合免疫治疗，已成为局部晚期非小细胞肺癌（NSCLC）的标准治疗方式。虽然该方法能改善病理缓解率，但其对机器人辅助胸外科手术（RATS）术后结局的影响尚未完全明确。 目的：本研究旨在评估新辅助治疗对接受RATS的NSCLC患者术后结局的影响，重点关注手术时间、中转开胸率及术后并发症。 方法：对2019年2月至2024年8月期间接受RATS的NSCLC患者进行回顾性队列分析。采用倾向评分匹配平衡组间术前特征。主要比较结局包括手术时间、中转开胸率及术后并发症，统计学显著性定义为p<0.05。 结果：共纳入253例患者，其中23例接受新辅助治疗（化疗或化疗联合免疫治疗），230例未接受。新辅助治疗组手术时间显著延长（250分钟 vs. 221分钟，p=0.001），但中转开胸率无显著差异（8.7% vs. 3.9%，p=0.5）。然而，新辅助治疗组术后持续性漏气（>5天）发生率更高（39.13% vs. 35.21%，p<0.001）。住院时间、胸腔引流持续时间等其他参数在组间均无统计学显著差异（分别为p=0.860和p=0.760）。 结论：本研究结果支持NSCLC患者接受新辅助治疗后行机器人辅助胸外科手术的可行性，表明该治疗模式可安全应用于特定患者的临床实践。未来需进一步研究以明确患者选择标准、优化术后管理策略，为复杂病例的个体化治疗提供指导。
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