To investigate the feasibility and efficacy of salvage lung resection and describe the possible indications and contraindications in patients with primary lung cancer.
Thirty patients undergoing anatomical salvage lung resection were classified into three groups: GI, patients with progressive lung tumor despite definitive chemo- and/or radiotherapy; GII, patients who underwent emergency resection; and GIII, patients in whom neoadjuvant or definitive chemo- and/or radiotherapy was contraindicated because of severe comorbidities. The groups were compared based on, peri- and postoperative factors, and survival rates.
The morbidity rate was 70%. Revision surgery was required in 23% of patients. Morbidity was affected by lower hematocrit and hemoglobin levels (P = 0.05). Mean hospital stay was 11 ± 4 days, which was longer in patients in whom complications developed (P = 0.0003). The in-hospital or 30-day mortality rate was 3%. Mean relapse-free survival and overall survivals were 14 ± 12 and 19 ± 13 months.
Patients with progression of the persistent primary tumor after definitive chemo- and/or radiotherapy can undergo salvage lung resection with acceptable mortality and high morbidity rates, if the tumor is considered resectable. Other indications may be considered for salvage lung resection based on each patient’s specific evaluation.
Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015;16(2):187–99. CrossRefPubMedPubMedCentral
Schreiner W, Dudek W, Lettmaier S, Fietkau R, Sirbu H. Should salvage surgery be considered for local recurrence after definitive chemoradiation in locally advanced non-small cell lung cancer. J Cardiothorac Surg. 2016. https://doi.org/10.1186/s13019-016-0396-0.
Uramoto H. Current topics on salvage thoracic surgery in patients with primary lung cancer. Ann Thorac Cardiovasc Surg. 2016. https://doi.org/10.5761/atcs.ra.16-00019.
Kuzmik GA, Detterbeck FC, Decker RH, Boffa DJ, Wang Z, Oliva IB, et al. Pulmonary resections following prior definitive chemoradiation therapy are associated with acceptable survival. Eur J Cardiothorac Surg. 2013. https://doi.org/10.1093/ejcts/ezt184.
Van Schill PE. Salvage surgery after stereotactic radiotherapy: a new challenge for thoracic surgeons. J Thorac Oncol. 2010;5(12):1881–2. CrossRef
Hishida T, Nagai K, Mitsudomi T, Yokoi K, Kondo H, Horinouchi H, et al. Salvage surgery for advanced non-small cell lung cancer after response to gefitinib. J Thorac Cardiovasc Surg. 2010. https://doi.org/10.1016/j.jtcvs.2010.06.035.
Van Breussegem A, Hendriks JM, Lauwers P, Van Schill PE. Salvage surgery after high-dose radiotherapy. J Thorac Dis. 2017;9(3):193–200. CrossRef
- Salvage thoracic surgery in patients with lung cancer: potential indications and benefits
Mehmet Oguzhan Ozyurtkan
Mazen Rasmi Alomari
- BioMed Central
Neu im Fachgebiet Chirurgie
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