Immune checkpoint inhibitors (ICIs) targeting the T-Cell programmed death receptor-1 (PD-1), showed improved survival in patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). However, the role of salvage thoracic surgery in the management of residual disease following immunotherapy or in patients with synchronous cancers has yet to be defined. There are very few reported cases of pulmonary resection in this patient cohort (1), with reported surgical challenges related to post-immunotherapy hilar fibrosis that frequently necessitates an open approach. In this video, we show that robotic-assisted lobectomy following immunotherapy is both safe and technically feasible.
Reference
- Chaft JE, Hellmann MD, Velez MJ, et al. Initial experience with lung cancer resection following treatment with t cell checkpoint inhibitor therapy. Annals of thoracic surgery. 2017;104:e217-e218
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Well performed lower lobectomy! However it is a pity that the authors did not show the most difficult part of this operation in an ycN2 tumour after I-T, namely the inter-lobar and central lymphadenectomy. Also none of the traces of the prior esophagectomy (and even less its lymphadenectomy) was shown.