Sleeve Lobectomy Following Neoadjuvant Therapy in NSCLC

Comparative Analysis of Minimally Invasive and Open Sleeve Lobectomy Following Neoadjuvant Therapy in NSCLC: A Multicenter Retrospective Evaluation of Surgical Outcomes

The goal of this observational, retrospective, multicenter cohort study is to evaluate the surgical and oncologic outcomes of sleeve lobectomy performed via minimally invasive (RATS/VATS) or open thoracotomy approaches in patients with non-small cell lung cancer (NSCLC) who have undergone neoadjuvant therapy, including chemotherapy, immunotherapy, or combination regimens. The main questions this study aims to answer are:

• Does minimally invasive sleeve lobectomy result in comparable or improved perioperative and postoperative outcomes compared to open thoracotomy following neoadjuvant treatment in NSCLC?
• Does surgical approach influence oncologic endpoints such as margin status, lymph node dissection, recurrence-free survival, and overall survival? This research addresses a critical gap in the thoracic oncology field by evaluating the safety, complexity, and efficacy of advanced surgical techniques in the context of evolving multimodal therapy paradigm. Findings may inform clinical decision-making and optimize patient selection in an era of increasing use of neoadjuvant strategies for resectable NSCLC.

Inclusion Criteria:

• Age ≥ 18 years
• Histologically confirmed NSCLC
• Undergoing sleeve lobectomy with curative intent
• Receipt of neoadjuvant therapy (chemotherapy, immunotherapy, target therapy, etc.)
• Surgical approach: either minimally invasive (VATS or RATS) or open thoracotomy
• Availability of complete perioperative and follow-up data (minimum 12-month follow-up or until death)
• Signed informative consent

Exclusion Criteria:

• Sublobar resections (e.g., segmentectomy) or pneumonectomy
• Absence of neoadjuvant therapy
• Purely diagnostic surgical procedures
• Incomplete medical records or lost to follow-up
• Metastatic (stage IV) disease at time of surgery