在2025年欧洲肺癌大会（ELCC）上，国际肺癌研究协会（IASLC）候任主席、上海市东方医院肿瘤科周彩存教授与2025 ELCC联合主席、意大利都灵大学胸外科Enrico Ruffini教授展开深度对话，讨论了新辅助化疗联合免疫治疗与微创手术的整合、围手术期免疫治疗患者选择、辅助治疗时长优化、降阶梯策略等议题，揭示了多学科协作下的治疗新范式。

 

 

Ruffini教授：这一问题在近年学术会议中经常被讨论，2025 ELCC专门设置了两场报告进行探讨。回顾历史经验，几十年前我为接受过化疗的患者进行手术，结果发现与直接手术相比，这类手术更加困难，主要归因于组织粘连、血管与肺实质及肿瘤存在解剖层次不清等问题。在新辅助化疗联合免疫治疗时代，手术复杂性进一步增加，可能是由于免疫治疗引发的炎症反应和纤维化（本质上属于治疗应答的病理表现）。但值得庆幸的是，外科技术也在不断进步，我们拥有更多手术技术和设备来处理术中并发症。

 

2025 ELCC展示的研究中，绝大多数接受新辅助化疗联合免疫的患者可通过微创手术完成治疗，接受胸腔镜手术或机器人微创手术的患者术后恢复更容易，且微创手术后患者对辅助治疗的耐受性也优于开胸手术。综上，我们能让这些患者安全地实施微创手术。

 

Dr.Ruffini:Thank you for the question.I think this is one of the questions we usually discuss at many conferences，and also this conference.Particularly at this conference，there will be two important presentations.One has just been done，and the other one is about to be discussed.About the complexity?Yes，surgical complexity after chemo-IO.When I was young，I started operating on patients after normal chemotherapy.We found it more difficult with respect to upfront surgery，because of adhesions，the loss of the planes between the vessels，the parenchyma and the tumor.We have found that after chemoimmunotherapy，surgery is even more difficult，probably because of inflammation and fibrosis induced by immunotherapy.This is the effect that we want of course for these patients.But on the other hand，we have developed improvements in the surgical technique.We have more technology.We have more devices，all to take care of intraoperative complications.In the series that was presented this morning，the vast majority of patients after chemoimmunotherapy could be operated by minimally invasive therapy，which is good，because patients after thoracoscopy or minimally invasive techniques are more ready to come back to normal life.The post-operative period is easier.These patients can much better tolerate adjuvant treatment compared to open access.So，we are working on this，we have the tools，and I am very confident that we can operate on these patients safely and with minimally invasive techniques.