Salvage surgery after chemo- or chemoradiotherapy for initially unresectable lung carcinoma.Ann Thorac Surg 2019AT
Salvage surgery is used for resection of loco-regionally recurrent or re-growing lesions after treatment for unresectable non-small cell lung cancer. It is also used to resect lesions that have regressed following treatment and that had not initially been indicated for resection. Relationships between salvage surgery, safety and prognosis, however, have remained unclear.
Between 2006 and 2017, 29 patients received salvage resection (median age: 60 years, 25 men and 4 women). Safety and prognosis were analyzed.
Tumor grade at the time of initial treatment was Stage III or IV in 23 and 6 patients, respectively. Twenty-two patients received chemoradiotherapy (radiation: 40-66 Gy) and seven received chemotherapy. Time from initial treatment to surgery ranged from 2-60 months. Segmentectomy, lobectomy, bi-lobectomy and pneumonectomy were performed in 1, 25, 2, and 1 patient, respectively. Combined resections were needed in 17 patients; this included 10 bronchoplasties, 9 pulmonary arterioplasties, 4 chest wall resections, and 1 great vessel resection. There was no 30-day postoperative mortality. Grade 3 or higher-grade postoperative complications (mostly cardiopulmonary) were observed in 11 patients. Five-year overall survival after initial treatment was 61%; after surgery it was 51%. Five-year relapse-free survival after surgery was 49%. On recurrent-free survival, patients with clinical stage III at the initial treatment, pathological stage 0-II, or a good response to initial treatment showed a favorable prognosis.
Although cardiopulmonary complications can accompany salvage surgery, the procedure is generally safe. Survival outcome is encouraging, especially in cases with good response to initial treatment.