Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
Ann Thorac Surg. 2020 Oct;110(4):1123-1130. doi: 10.1016/j.athoracsur.2020.04.035. Epub 2020 May 28.
Patients with locally advanced, non-small cell lung cancer treated with definitive chemoradiotherapy alone often demonstrate persistent or recurrent disease. In the absence of systemic progression, salvage lung resection after definitive chemoradiotherapy has been used as a treatment option. Given the paucity of data, we sought to evaluate the safety and efficacy of salvage pulmonary resections occurring greater than 90 days after definitive chemoradiotherapy.
Retrospective institutional database review identified patients undergoing salvage lung resection at least 90 days after the completion of definitive chemoradiotherapy. Primary outcomes evaluated were overall survival and recurrence-free survival.
Thirty patients met inclusion criteria between January 1, 2004 and December 31, 2015. Median time to surgery after definitive radiotherapy was 279 days (interquartile range, 168-474 days). Extended resections were performed in 11 patients (37%). Ottawa Thoracic Morbidity and Mortality Classification System grade IIIA or greater complications occurred in 12 patients (40%). Thirty-day mortality was 6.7% (2 patients). Median overall survival after salvage resection was 24 months. Median overall survival for an R1 resection was 5.3 months vs 108 months for an R0 resection (P = .001). Persistent pN1-positive salvage resections also did less well compared with pN0 (8.9 vs 28.2 months; P = .06). For patients who underwent nonextended salvage resection (simple lobectomy or simple pneumonectomy), median overall survival was 108.4 months, vs 8.9 months for extended salvage resections (P = .02).
With proper patient selection, salvage lung resections can be performed with acceptable morbidity, mortality, and oncologic outcomes, particularly when a ypN0R0 resection can be achieved by nonextended surgical means.
单独接受根治性放化疗的局部晚期非小细胞肺癌患者常表现出疾病持续或复发。在没有全身进展的情况下，根治性放化疗后进行挽救性肺切除术已被用作一种治疗选择。鉴于数据有限，我们试图评估根治性放化疗后 90 天以上发生的挽救性肺切除术的安全性和有效性。
回顾性机构数据库检索确定了至少在根治性放化疗完成后 90 天接受挽救性肺切除术的患者。主要评估的结果是总生存率和无复发生存率。
2004 年 1 月 1 日至 2015 年 12 月 31 日期间，有 30 名患者符合纳入标准。根治性放疗后手术的中位时间为 279 天（四分位距，168-474 天）。11 名患者（37%）进行了扩展切除术。12 名患者（40%）发生 Ottawa 胸外科并发症 IIIA 级或更高级别并发症。30 天死亡率为 6.7%（2 名患者）。挽救性切除术后的中位总生存率为 24 个月。R1 切除的中位总生存率为 5.3 个月，而 R0 切除的中位总生存率为 108 个月（P=0.001）。持续性 pN1 阳性挽救性切除也不如 pN0 （8.9 个月与 28.2 个月；P=0.06）。对于未行扩展挽救性切除术（单纯肺叶切除术或单纯全肺切除术）的患者，中位总生存率为 108.4 个月，而行扩展挽救性切除术的患者中位总生存率为 8.9 个月（P=0.02）。
通过适当的患者选择，挽救性肺切除术可以在可接受的发病率、死亡率和肿瘤学结果下进行，特别是当通过非扩展手术手段可以实现 ypN0R0 切除时。
