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Salvage surgery after chemo- or chemoradiotherapy for initially unresectable lung carcinoma.

Abstract

BACKGROUND

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.

METHODS

Between 2006 and 2017, 29 patients received salvage resection (median age: 60 years, 25 men and 4 women). Safety and prognosis were analyzed.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: mysonobe@kuhp.kyoto-u.ac.jp.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31445048

Citation

Sonobe, Makoto, et al. "Salvage Surgery After Chemo- or Chemoradiotherapy for Initially Unresectable Lung Carcinoma." The Annals of Thoracic Surgery, 2019.
Sonobe M, Yutaka Y, Nakajima D, et al. Salvage surgery after chemo- or chemoradiotherapy for initially unresectable lung carcinoma. Ann Thorac Surg. 2019.
Sonobe, M., Yutaka, Y., Nakajima, D., Hamaji, M., Menju, T., Ohsumi, A., ... Date, H. (2019). Salvage surgery after chemo- or chemoradiotherapy for initially unresectable lung carcinoma. The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2019.06.087.
Sonobe M, et al. Salvage Surgery After Chemo- or Chemoradiotherapy for Initially Unresectable Lung Carcinoma. Ann Thorac Surg. 2019 Aug 21; PubMed PMID: 31445048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Salvage surgery after chemo- or chemoradiotherapy for initially unresectable lung carcinoma. AU - Sonobe,Makoto, AU - Yutaka,Yojiro, AU - Nakajima,Daisuke, AU - Hamaji,Masatsugu, AU - Menju,Toshi, AU - Ohsumi,Akihiro, AU - Chen-Yoshikawa,Toyofumi F, AU - Sato,Toshihiko, AU - Date,Hiroshi, Y1 - 2019/08/21/ PY - 2019/01/08/received PY - 2019/04/30/revised PY - 2019/06/24/accepted PY - 2019/8/25/entrez PY - 2019/8/25/pubmed PY - 2019/8/25/medline JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. N2 - BACKGROUND: 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. METHODS: Between 2006 and 2017, 29 patients received salvage resection (median age: 60 years, 25 men and 4 women). Safety and prognosis were analyzed. RESULTS: 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. CONCLUSIONS: 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/31445048/Salvage_surgery_after_chemo-_or_chemoradiotherapy_for_initially_unresectable_lung_carcinoma L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(19)31207-X DB - PRIME DP - Unbound Medicine ER -