Surgical Complexity and Perioperative Feasibility Following Neoadjuvant Chemotherapy, Chemoradiotherapy, or Chemoimmunotherapy in Stage II–III Non-Small Cell Lung Cancer: A Retrospective Single-Institution Study

Background: Neoadjuvant chemoimmunotherapy is a standard option for resectable stage II–III non-small cell lung cancer (NSCLC); however, its impact on surgical feasibility, operative complexity, and perioperative outcomes remains incompletely characterized. We compared surgical feasibility, complexity, and perioperative outcomes across different neoadjuvant strategies. Methods: This single-center retrospective study included patients with stage II–III NSCLC who underwent curative-intent resection following neoadjuvant chemoimmunotherapy (neo-CIT), chemotherapy alone (neo-CT), or chemoradiotherapy (neo-CRT) during the same period. Surgical complexity was assessed using a four-level empirical grading scale. Perioperative outcomes, pathological response, and complications were compared among treatment groups using appropriate nonparametric statistical methods. Results: Twenty-four patients were included in the analysis (neo-CIT, n = 8; neo-CT, n = 12; neo-CRT, n = 4). R0 resection was achieved in 100%, 83.3%, and 100% of patients in the neo-CIT, neo-CT, and neo-CRT groups, respectively. Operative time, estimated blood loss, length of hospital stay, and overall postoperative complication rates did not differ significantly among groups. Thirty-day mortality was 0% in all groups, and 90-day mortality was 12.5% in the neo-CIT group and 0% in the neo-CT and neo-CRT groups. Surgical complexity scores were high across all cohorts and, when analyzed across the entire cohort, were not significantly associated with longer operative time (P = 0.16), greater blood loss (P = 0.83), or pathological response (P = 0.55). Neo-CIT was not associated with higher conversion rates or increased objective perioperative risk compared with neoadjuvant chemotherapy or chemoradiotherapy. Conclusions: In this single-institution exploratory analysis, neoadjuvant chemoimmunotherapy appeared to be surgically feasible and did not result in an apparent increase in perioperative risk compared with other neoadjuvant strategies. Although surgeons perceived increased operative complexity, objective perioperative risk remained acceptable when procedures were performed by experienced thoracic surgeons. However, considering the limited sample size and lack of statistical power, these findings should be interpreted with caution and should not be considered evidence of equivalence.