The Annals of thoracic surgery
March 31, 2026 · via Europe PMC
Impact of Neoadjuvant Therapy, Tumor Size, and Surgical Approach on Conversion to Open Thoracotomy During Lobectomy.
Pohlman A, Marten AD, Coughlin JM, Lubawski J, Raad W, Abdelsattar ZM.
AI summary — for doctors, generated from the abstract only
After neoadjuvant therapy for stage II-III NSCLC, more than 1 in 10 minimally invasive lobectomies converted to open, with the robotic approach associated with a 54% relative reduction in conversion versus VATS.
What was studied
National hospital-level database study of 3937 patients undergoing minimally invasive lobectomy after neoadjuvant therapy (2010-2022), comparing robotic and VATS.
Key findings
- 515 (13.1%) converted to open
- Conversion 15.1% after chemoradiotherapy, 12.8% after chemotherapy, 9.6% after chemoimmunotherapy
- Robotic approach associated with 54% relative risk reduction in conversion vs VATS (specific statistic not fully captured in the abstract)
Clinical relevance
This suggests a robotic approach may reduce conversions in post-neoadjuvant lobectomy, though selection and surgeon factors may confound.
Who should care
Limitations
Retrospective national data without surgeon experience data; detailed secondary outcomes truncated.
Robotic lobectomy after neoadjuvant therapy converts to open less often than VATS.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Neoadjuvant therapy options for non-small cell lung cancer (NSCLC) are increasingly used before minimally invasive resection. These operations are generally more challenging and have higher rates of conversion to open surgery. In this context, we compare perioperative outcomes of robotic and video-assisted thoracoscopic surgery (VATS) after neoadjuvant therapy.
Methods
We used national hospital-level data to identify adult patients diagnosed with stage II or III NSCLC undergoing minimally invasive lobectomy after neoadjuvant chemoimmunotherapy, chemoradiotherapy, or chemotherapy alone between 2010 and 2022. Patients were split into robotic and VATS cohorts. The primary outcome was conversion to open surgery, and secondary outcomes included lymph node yield, length of stay, readmission, and 30-day and 90-day mortality. Multivariable logistic and negative binomial regressions were created to account for patient demographics and tumor characteristics.
Results
Of 3937 patients fitting inclusion criteria, 515 (13.1%) were converted to open, including 15.1% after chemoradiotherapy, 12.8% after chemotherapy alone, and 9.6% after chemoimmunotherapy (P < .001). Robotic surgery was performed in 1745 patients (44.3%) with 137 (7.9%) conversions, and VATS was used in 2192 patients (55.7%) with 378 (17.2%) conversions (P < .001). VATS was independently associated with conversion to open thoracotomy (adjusted odds ratio, 1.98; P < .001). All other short-term outcomes were similar between groups.
Conclusions
Conversions from minimally invasive to open surgery occur in >1 in 10 patients receiving neoadjuvant therapy for lung cancer. The robotic approach is associated with a 54% relative risk reduction in open conversions compared with VATS.
DOI
10.1016/j.athoracsur.2026.03.046
PMID
41933782
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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