160P Perioperative and patient reported outcomes of robotic-assisted and video-assisted thoracoscopic surgery for patients with NSCLC receiving neoadjuvant immunotherapy: A real-world cohort study

Neoadjuvant immunochemotherapy (Neo-IC) followed by radical resection has become the first-line therapy for local advanced wild-type non-small cell lung cancer (NSCLC), which also increases the complexity of the operation due to the therapy-related tissue texture change or general adhesion. Robotic-assisted thoracoscopic surgery (RATS) has become increasingly applied but the comprehensive safety and feasibility concerning life quality for this population is not yet to be analyzed. A retrospective analysis was conducted for NSCLC patients who underwent either RATS or video-assisted thoracoscopic lobectomy (VATS) following Neo-IC at a single institution between October 2019 and October 2023. We analyzed and compared the clinical characteristic and perioperative outcome between RATS and VATS. The Patient Reported Outcome (PRO) was prospectively collected in a subset of the cohort for further analysis. A total of 246 cases (94 RATS, 152 VATS) were included. Of these, 138 of 246 (56.1%) patients had a major pathological response, and 97 (39.4%) had a pathological complete response based on pathological examination of surgical specimen. No significant differences were found in age, gender, BMI, clinical stage, ASA grade, conversion rate, chest tube duration and intraoperative blood loss between two groups. RATS were significantly associated with more N2 station dissected (p = 0.018), and reduced postoperative length of stay (p = 0.006). In the PRO data we found more severe chest pain was reported by VATS group during hospitalization (p = 0.027), but after discharge RATS group reported more severe cough (p = 0.012) and disturbed sleep (p = 0.025). Patients receiving Neo-IC in this real-world study exhibited promising pathological remission rates. RATL demonstrated comparable safety and feasibility, with superior perioperative outcomes compared to VATL approaches. However, a more extended dissection of mediastinal lymph nodes might be associated with chronic cough, which impaired the long-term life quality.