Impact of Neoadjuvant Immunotherapy Combined with Chemotherapy on Surgical Margin Strategy in Central Non-Small-Cell Lung Cancer

Why clinicians should know about it

• Picked for Surgical Oncology (paper of the day, 5 October 2026): Neoadjuvant immunotherapy impacts surgical margin strategy in NSCLC

Abstract

BACKGROUND: The CheckMate 816 trial showed that neoadjuvant immunotherapy combined with chemotherapy improved pathological complete response and tumor downstaging compared with chemotherapy alone. Whether this permits less extensive resection, such as reduced margins, without compromising survival remains unclear. METHODS: We included 142 patients with central-type non-small-cell lung cancer (NSCLC) who received neoadjuvant chemoimmunotherapy at three hospitals between 2017 and 2022. All were initially considered candidates for sleeve lobectomy (SLT) based on pretreatment findings. After treatment, patients with residual disease confined to the segmental bronchus and/or distal pulmonary parenchyma were considered eligible for lobectomy (LT). Patients underwent SLT or LT according to pretreatment or post-treatment tumor extent, respectively. Negative margins were confirmed by intraoperative frozen-section pathology. Propensity score weighting (PSW) was used to balance baseline characteristics. RESULTS: Of the 142 enrolled patients, 86 had a radiographic response, with bronchoscopy revealing tumor regression to the segmental bronchus or more proximal airways. Ultimately, 82 patients underwent surgery, seven of whom were lost to follow-up during the follow-up period. Among 75 patients, 30 (40.0%) underwent SLT and 45 (60.0%) converted to LT. Grade II-V complications occurred in one case (2.22%) in the LT group and seven cases (23.3%) in the SLT group (relative risk 0.09; 95% confidence interval 0.01-0.57; p < 0.05). After PSW, baseline characteristics were balanced between groups (p > 0.05). PSW-adjusted event-free survival showed no significant difference between groups (hazard ratio 0.53; 95% confidence interval 0.13-2.22; p > 0.05). CONCLUSION: For central-type NSCLC initially planned for SLT, conversion to LT is feasible when adequate negative margins are confirmed after neoadjuvant chemoimmunotherapy, potentially avoiding more extensive surgery.

Abstract as published, via PubMed.