Safety of salvage lung resection after immunotherapy for unresectable non-small cell lung cancer

Tsuyoshi Ueno, Motohiro Yamashita, Natsumi Yamashita, Masashi Uomoto, Osamu Kawamata, Yoshifumi Sano, Hidetoshi Inokawa, Shin Hirayama, Mikio Okazaki, Shinichi Toyooka

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The safety of salvage lung resection after immune checkpoint inhibitor (ICI) therapy in patients with advanced non-small cell lung cancer (NSCLC) is not well understood. Methods: In this retrospective multicenter study, we reviewed perioperative morbidity and mortality rates in 11 patients (8 men, 3 women; median age 70 years) who underwent salvage lung resection for unresectable NSCLC after ICI therapy in the 4 years since 2017. Operative factors were also compared according to operating time (> 6 h, n = 7; < 6 h, n = 4). Results: The clinical stage at the time of diagnosis was IIIA in 2 patients, IIIB in 4, IVA in 2, and IVB in 3. Eight patients received pembrolizumab and 3 received durvalumab. Two patients received an ICI agent alone, 3 underwent chemoradiotherapy, and 6 received chemotherapy. Lobectomy was performed in 10 cases and bilobectomy in 1 case. All patients underwent complete resection. Median operating time was 429 (range 169–570) min with a median blood loss of 199 (range 10–5, 140) mL. The only intraoperative complication was damage to the pulmonary artery. The perioperative morbidity and mortality rates were 27% and 0%, respectively. The 90-day mortality rate was 9% (1 patient died of acute exacerbation of interstitial pneumonia). Patients in whom the operating time was > 6 h more frequently had lymph node metastasis at the time of initial diagnosis (100% vs 25%, p = 0.02). Conclusions: Salvage lung resection was tolerated after ICI therapy in these patients. Lymph node metastasis at the time of initial diagnosis might make salvage surgery difficult.

Original languageEnglish
JournalGeneral Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • Immunotherapy
  • Non-small cell lung cancer
  • Salvage surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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