Clinical application and potential benefits of En-bloc biopsy based on minimally invasive surgery in advanced lung cancer

Background and objective: Traditional biopsy methods often limit diagnostic accuracy and treatment options due to inadequate tissue samples. En-bloc biopsy (EB), a minimally invasive technique, offers adequate tissue for both pathological and genetic analysis while reducing tumor burden. This study evaluates the clinical applicability and survival benefits of EB in advanced lung cancer. Methods: We retrospectively reviewed advanced lung cancer patients with pulmonary tumors and distant metastases confirmed by PET-CT, who underwent EB via video-assisted thoracoscopic surgery (VATS) at our center from 2010 to 2020. Clinical characteristics, pathological and genetic results, surgical details, and survival data were analyzed. Kaplan-Meier and Log-Rank tests were used to compare overall survival (OS) between: (1) targeted vs. non-targeted therapies within the EB group, and (2) EB vs. traditional biopsy, with further subgroup analysis focusing on targeted therapy recipients and stage IVA patients. Results: Among 142 patients (majority male, non-smokers, under 65, ECOG 0–1), 128 (90.1 ​%) had adenocarcinoma. No severe perioperative complications or early postoperative deaths occurred. All 132 genetic samples were valid; 62.9 ​% were EGFR-positive. Median follow-up was 52.0 months; median OS, 66.0 months. In the EB group, targeted therapy was linked to longer OS than non-targeted (80.0 vs. 43.0 months, p ​= ​0.0445). EB outperformed traditional biopsy in OS (66.0 vs. 28.0 months, p ​= ​0.0025). Subgroups receiving targeted therapy (HR ​= ​0.55, p ​= ​0.0260) and with stage IVA disease (HR ​= ​0.66, p ​= ​0.0338) showed survival benefit. Conclusion: VATS-based EB is safe and feasible in advanced lung cancer, improves access to precision therapy, and significantly prolongs survival.