Risk factors for postoperative pulmonary complications in non-adenocarcinoma non-small cell lung cancer patients undergoing surgery after neoadjuvant therapy.

Background: Neoadjuvant therapy followed by surgery is the recommended treatment for patients with locally advanced lung cancer. No studies have examined the risk factors of postoperative pulmonary complications (PPCs) in this group of patients. The addition of immune checkpoint inhibitors (ICIs) can improve the efficacy of neoadjuvant therapy; however, it is unknown whether ICIs will also increase the PPC incidence. Thus, we conducted this study to identify the predictors of PPCs. Methods: We reviewed the database of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. Patients with non-adenocarcinoma non-small cell lung cancer (non-ADC NSCLC) who underwent surgery after neoadjuvant therapy were included. The clinical information was collected, the PPCs and mortality were evaluated. Results: The cohort in this study consisted of 108 patients. Among them, 36 had PPCs, and the incidence of PPCs was 33.3% (36/108). The majority of PPCs were prolonged time to chest tube removal and pneumonia. One patient died within 30 days due to serious postoperative complications. The mortality within 30 days was 0.9%. The addition of ICIs to neoadjuvant therapy did not increase the incidence of PPCs, but the operation time was longer in the ICI group. Multivariate analysis indicated that age, blood urea nitrogen (BUN) level and N2 stage may be superior predictors of PPCs. Conclusions: The addition of ICIs did not increase the incidence of PPCs but did prolong the operation time. Age, BUN level, and N2 stage were excellent predictors of PPCs in non-ADC NSCLC patients treated with surgery after neoadjuvant therapy.