Optimizing Early-Stage NSCLC Management Through Multidisciplinary Strategies: ASCO 2025 - Episode 11
Surgical Attrition in Resectable NSCLC: Risk Factors, Patient Communication, and Strategies to Optimize Continuity of Care
Panelists discuss how neoadjuvant chemoimmunotherapy maintains acceptable surgical safety profiles with mortality rates under 4% and how technical complexity primarily stems from hilar lymph node involvement rather than the systemic therapy itself, requiring experienced surgeons to handle these cases.
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Brendon Stiles, MD, and Mara Antonoff, MD, FACS, address the persistent concern of surgical attrition—patients who fail to undergo planned resection after neoadjuvant therapy. Despite the benefits of chemoimmunotherapy, delays, disease progression, or complications can prevent surgery, emphasizing the need for early multidisciplinary engagement.
Stiles highlights that trials like CheckMate 816 have shown consistently low 90-day mortality rates (< 4%) and relatively low major complication rates (< 20%), suggesting surgery remains safe even after neoadjuvant therapy. However, patients with N2 disease represent a significant risk group, requiring rigorous evaluation and patient-specific planning.
Antonoff adds that although surgery post neoadjuvant therapy can be technically complex due to hilar node involvement, experienced surgeons can manage these challenges effectively. She stresses the importance of surgical preparedness, institutional expertise, and transparent communication with patients to prevent unnecessary ineligibility and optimize outcomes
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