Outcomes of robotic anatomic lung resection after neoadjuvant therapy for non-small cell lung cancer.

Background: Previous studies report a 20% conversion to open thoracotomy and 25% major morbidity rate for minimally invasive thoracic surgery following neoadjuvant chemotherapy or immunotherapy. Methods: This retrospective review includes a consecutive (non-selected) series of patients from two surgeons who underwent robotic resection after neoadjuvant therapy for non-small cell lung cancer. Results: From January 2018 to October 2024, 150 patients (51% male) underwent surgery following systemic therapy. The median age was 67 years. Preoperatively, 92% received chemotherapy, 65% immunotherapy, and 27% radiation. Median time from therapy to surgery was 6 weeks. The most common tumor type was stage IIIA adenocarcinoma (25%). Median operative time was 152 min, and median blood loss was 20 mL. There were no unplanned conversions to open thoracotomy or from lobectomy to pneumonectomy. Median length of stay was 1 day; 28% had chest tube removed on the day of surgery. Twenty-one patients experienced Clavien-Dindo grade III complications (primarily atrial fibrillation and effusion). There were no 30-day mortalities and two 90-day mortalities. Median follow-up was 19 months, with a median postoperative survival of 513 days. Conclusion: Robotic lobectomy and pneumonectomy can be safely performed after neoadjuvant therapy, with conversion rates <1% and minimal 30- and 90-day mortality. Key technical factors include intra-pericardial control of the pulmonary artery, division of the lobar airway prior to pulmonary artery dissection, and performing surgery within 6 weeks of completing neoadjuvant therapy.