Safety and efficacy of salvage surgery for non-small cell lung cancer: a retrospective study of 46 patients from four Keio-affiliated hospitals

• DOI: 10.1007/s11748-022-01808-4
• Publication Date: 2022-03-28T12:08:42Z
• Authors: Shigeki Suzuki; Keisuke Asakura; Masayuki Okui; Makoto Sawafuji; Takao Shigenobu; Atsushi Tajima; Kaoru Kaseda; Kyohei Masai; Tomoyuki Hishida; Hisao Asamura
• Keywords: Salvage Therapy; Lung Neoplasms; Chemoradiotherapy; Hospitals; 3. Good health; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Carcinoma, Non-Small-Cell Lung; Disease Progression; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies

Advances in drug therapy and radiotherapy for non-small cell lung cancer resulted in an increased number of salvage surgeries for initially unresectable tumors. This study aimed to evaluate the safety and efficacy of salvage surgery for non-small cell lung cancer.We defined salvage surgery as (1) surgery for local recurrence/residual tumor after definitive chemoradiotherapy/radiotherapy (salvage surgery in a narrow sense) or (2) conversion surgery after non-surgical treatment. We retrospectively analyzed patients who underwent salvage surgery at four Keio University-affiliated hospitals.Forty-six patients were included. The initial clinical stage was I in 4 patients (9%), III in 19 (41%), and IV in 23 (48%). Initial treatment before salvage surgery was chemoradiotherapy in 10 patients (24%), radiotherapy in 4 (9%), and drug therapy in 32 (67%). Pneumonectomy, lobectomy, segmentectomy, and wedge resection were performed in 2 (4%), 37 (80%), 3 (7%), and 4 (9%) patients, respectively. Complete resection was achieved in 41 patients (89%). Postoperative complications occurred in 11 patients (24%). Initial chemoradiotherapy/radiotherapy was an independent predictor of postoperative complications (odds ratio 10, p = 0.03). The 30- and 90-day mortality rates were 0 and 2%, respectively. The 5-year overall and progression-free survival rates were 66 and 30%, respectively.The safety and efficacy of salvage surgery for non-small cell lung cancer were acceptable. Salvage surgery was a viable treatment option for selected patients with recurrent/residual tumors after non-surgical treatments.