To retrospectively analyze the cases of video-assisted thoracoscopic sleeve lobectomy after neoadjuvant therapy for locally advanced lung cancer in the Second Affiliated Hospital Zhejiang University School of Medicine. The perioperative outcomes were summarized to explore the feasibility and safety of the minimally invasive surgical techniques.

Patients with locally advanced lung cancer who underwent thoracoscopic sleeve lobectomy after neoadjuvant therapy in our center from January 2014 to December 2023 were consecutively enrolled. Clinical data were collected, and regular follow-up by telephone and clinic visits were conducted.

A total of 56 patients with non-small cell lung cancer (NSCLC) were enrolled, with an age of (63.7±7.3) years, of which 54 were males (96.4%) . 26 patients performed right upper lobe sleeve lobectomy, 14 performed left upper lobe sleeve lobectomy, and 11 performed left lower lobe sleeve lobectomy. The main pathological type was squamous cell carcinoma (48 cases) . As for neoadjuvant therapy, 28 patients received chemo-immunotherapy, 21 received chemotherapy, and 7 received targeted therapy combined with chemotherapy. There were 3, 15, and 36 patients in TNM stage ⅠB, Ⅱ, and Ⅲ before treatments, respectively. And after induction therapy, there were 11, 16, 22, and 7 cases in stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. 75.0% of them underwent uniportal video-assisted thoracoscopic sleeve lobectomy, and 13 patients underwent robotic-assisted thoracic surgery. The total conversion rate was 3.6% (2/56) . The mean operation duration was (3.4±1.0) h, the mean intraoperative blood loss was (111.4±169.4) mL, and the mean duration of drainage was (6.0±3.2) d. Regarding lymph node dissection, the mean station was 8.1±1.8, and the total number of lymph nodes was 25.7±9.7. The negative rate of surgical margin was 98.2%. And the pathologic complete response rate was 19.6%. There were 17 cases with perioperative complications, including 1 perioperative death. After surgical treatment, 51 patients (91.1%) received adjuvant therapy, including 28 with adjuvant immunotherapy. The median follow-up time was 25.5 (2–119) months. The 1-year and 3-year overall survival rates were 94.5%, and 78.0%, respectively; and the 1-year and 3-year progression-free survival rates were 82.4%, and 67.6%, respectively.

With the continuous improvement of minimally invasive techniques, video-assisted thoracoscopic sleeve lobectomy can achieve radical resection of locally advanced NSCLC after induction therapy. Minimally invasive sleeve lobectomy is challenging and technique-demanding, which is feasible and safe when performed in high-volume and proficient centers.