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

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan

    Shigeki Suzuki

  2. Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Shigeki Suzuki, Keisuke Asakura, Kaoru Kaseda, Kyohei Masai, Tomoyuki Hishida & Hisao Asamura

  3. Department of General Thoracic Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan

    Masayuki Okui & Makoto Sawafuji

  4. Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan

    Takao Shigenobu & Atsushi Tajima

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  1. Shigeki Suzuki
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  2. Keisuke Asakura
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  3. Masayuki Okui
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Correspondence to Keisuke Asakura.

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Conflict of interests

KA, KM, KK, TH, and HA received unrestricted institutional funds from Eli Lilly Japan K.K., Shionogi & Co., Ltd., Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Kyowa Kirin Co., Ltd., and Covidien Japan Inc.

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Suzuki, S., Asakura, K., Okui, M. et al. Safety and efficacy of salvage surgery for non-small cell lung cancer: a retrospective study of 46 patients from four Keio-affiliated hospitals. Gen Thorac Cardiovasc Surg 70, 891–899 (2022). https://doi.org/10.1007/s11748-022-01808-4

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  • DOI: https://doi.org/10.1007/s11748-022-01808-4

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