Skip to main content

Advertisement

SpringerLink
Log in

Salvage extended surgery after immune-checkpoint inhibitor treatment for advanced non-small cell lung cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the surgical outcomes of salvage extended surgery after definitive medical treatment with an immune-checkpoint inhibitor (ICI) for locally advanced or unresectable non-small-cell lung cancer (NSCLC).

Methods

The subjects of this single-center retrospective analysis were 14 patients who underwent salvage surgery after ICI treatment between May, 2017 and April, 2023 at our institute. We reviewed the comprehensive surgical outcomes, including operative procedures, intraoperative findings, and postoperative morbidities. Overall survival (OS) was calculated using a Kaplan–Meier estimation.

Results

The initial clinical stage before medical treatment (c-stage) was stage III in eight patients, stage IV in five patients, and one patient had postoperative lung cancer recurrence. The indications for surgery were as follows: local control for relapse or residual tumor in ten patients and discontinuation of systemic therapy because of treatment-related complications in four patients. The surgical modes were segmentectomy (n = 1), lobectomy (n = 4), bilobectomy (n = 3), pneumonectomy (n = 6), and bronchoplasty (n = 7). Grade 3 or higher postoperative morbidities were observed in six patients, including only one case of 90-day mortality.

Conclusions

Our series demonstrated that the surgical outcome of salvage extended surgery after ICI therapy may be positive with careful selection of the procedure and indication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    Article  CAS  PubMed  Google Scholar 

  2. Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017. https://doi.org/10.1093/annonc/mdx222.

    Article  PubMed  Google Scholar 

  3. Yamamoto N, Nakagawa K, Nishimura Y, Tsujino K, Satouchi M, Kudo S, et al. Phase III study comparing second-and third-generation regimens with concurrent thoracic radiotherapy in patients with unresectable stage III non-small-cell lung cancer: west japan thoracic oncology group WJTOG0105. J Clin Oncol. 2010;28:3739–45.

    Article  PubMed  Google Scholar 

  4. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al. Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N Engl J Med. 2017;377(20):1919–29.

    Article  CAS  PubMed  Google Scholar 

  5. Durm GA, Jabbour SK, Althouse SK, Liu Z, Sadiq AA, Zon RT, et al. A phase 2 trial of consolidation pembrolizumab following concurrent chemoradiation for patients with unresectable stage III non-small cell lung cancer: hoosier cancer research network LUN 14–179. Cancer. 2020;126(19):4353–61.

    Article  CAS  PubMed  Google Scholar 

  6. Horn L, Mansfield AS, Szczęsna A, Havel L, Krzakowski M, Hochmair MJ, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379(23):2220–9.

    Article  CAS  PubMed  Google Scholar 

  7. Bauman JE, Mulligan MS, Martins RG, Kurland BF, Eaton KD, Wood DE. Salvage lung resection after definitive radiation (>59 Gy) for non-small cell lung cancer: surgical and oncologic outcomes. Ann Thorac Surg. 2008;86:1632–8.

    Article  PubMed  Google Scholar 

  8. Yang CF, Meyerhoff RR, Stephens SJ, Singhapricha T, Toomey CB, Anderson KL, et al. Long-term outcomes of lobectomy for non-small cell lung cancer after definitive radiation treatment. Ann Thorac Surg. 2015;99:1914–20.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bograd AJ, Mann C, Gorden JA, Gilbert CR, Farivar AS, Aye RW, et al. Salvage lung resections after definitive chemoradiotherapy: a safe and effective oncologic option. Ann Thorac Surg. 2020;110:1123–30.

    Article  PubMed  Google Scholar 

  10. Shepherd FA, Ginsberg R, Patterson GA, Feld R, Goss PE, Pearson FG, et al. Is there ever a role for salvage operations in limited small-cell lung cancer. J Thorac Cardiovasc Surg. 1991;101(2):196–200.

    Article  CAS  PubMed  Google Scholar 

  11. Shimizu K, Ohtaki Y, Suzuki K, Date H, Yamashita M, Iizasa T, et al. Salvage surgery for non-small cell lung cancer after defenitive radiotherapy. Ann Thorac Surg. 2021;11:862–73.

    Article  Google Scholar 

  12. Watanabe Y, Suzuki K, Hattori A, Fukui M, Matsunaga T, Oh S, et al. Bronchoplastic procedure versus pneumonectomy after high-dose radiation for non-small cell lung cancer. Ann Thorac Surg. 2021;112(6):1832–40.

    Article  PubMed  Google Scholar 

  13. The Japan Lung Cancer Society. General rule for clinical and pathological record of lung cancer. 8th ed (revised version). Tokyo: Kanehara-Shuppan. Co; 2021.

  14. Bott MJ, Cools-Lartigue J, Tan KS, Dycoco J, Bains MS, Downey RJ, et al. Safety and feasibility of lung resection after immunotherapy for metastatic or unresectable tumors. Ann Thorac Surg. 2018;106(1):178–83.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Smith A, Wali A, Montes A, Hadaki M, Harrison-Phipps K, Karapanagiotou EM, et al. Salvage pulmonary resection in stages IIIb-IV lung cancer after treatment with immune checkpoint inhibitors case series and literature review. J Surg Oncol. 2022;125(2):290–8.

    Article  CAS  PubMed  Google Scholar 

  16. Ueno T, Yamashita M, Yamashita N, Uomoto M, Kawamata O, Sano Y, et al. Safety of salvage lung resection after immunotherapy for unresectable non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2022. https://doi.org/10.1007/s11748-022-01798-3.

    Article  PubMed  Google Scholar 

  17. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. International association for the study of lung cancer staging and prognostic factors committee, advisory boards, and participating institutions; international association for the study of lung cancer staging and prognostic factors committee advisory boards and participating institutions the IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016. https://doi.org/10.1016/j.jtcvs.2010.02.039.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Weder W, Collaud S, Eberhardt WE, Hillinger S, Welter S, Stahel R, et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139(6):1424–30.

    Article  PubMed  Google Scholar 

  19. Junker K, Thomas M, Schulmann K, Klinke F, Bosse U, Müller KM. Tumour regression in non-small-cell lung cancer following neoadjuvant therapy histological assessment. J Cancer Res Clin Oncol. 1997;123(9):469–77.

    Article  CAS  PubMed  Google Scholar 

  20. Hattori A, Matsunaga T, Fukui M, Takamochi K, Oh S, Suzuki K, et al. Surgical outcome after extended sleeve lobectomy in centrally located non-small cell lung cancer. Ann Thorac Surg. 2022;S0003–4975(22):00480–5.

    Google Scholar 

  21. Watanabe I, Hattori A, Fukui M, Matsunaga T, Takamochi K, Suzuki K. Pulmonary artery reconstruction for non–small cell lung cancer: Surgical management and long-term outcomes. J Thorac Cardiovasc Surg. 2015. https://doi.org/10.1056/NEJMoa1504627.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373:123–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373:1627–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Herbst RS, Baas P, Kim DW, Felip E, Pérez-Gracia JL, Han JY, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387:1540–50.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan

    Eisuke Goto, Aritoshi Hattori, Mariko Fukui, Takeshi Matsunaga, Kazuya Takamochi & Kenji Suzuki

Authors
  1. Eisuke Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aritoshi Hattori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariko Fukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeshi Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuya Takamochi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenji Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aritoshi Hattori.

Ethics declarations

Conflict of interest

We have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goto, E., Hattori, A., Fukui, M. et al. Salvage extended surgery after immune-checkpoint inhibitor treatment for advanced non-small cell lung cancer. Surg Today (2024). https://doi.org/10.1007/s00595-024-02812-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00595-024-02812-2

Keywords

Search

Navigation