Department of Thoracic Surgery, Guy's Hospital, London, UK.
Department of Oncology, Guy's Hospital, London, UK.
J Surg Oncol. 2022 Feb;125(2):290-298. doi: 10.1002/jso.26691. Epub 2021 Sep 27.
The role of salvage thoracic surgery in managing advanced-stage lung cancer following treatment with immune checkpoint inhibitors is currently unclear. We present a series of nine patients with advanced non-small-cell lung cancer who underwent pulmonary resection following treatment with pembrolizumab.
We performed a single-institution retrospective analysis of pulmonary resection undertaken following treatment with pembrolizumab for advanced-stage lung cancer. Nine patients met the inclusion criteria.
In six cases, surgery was indicated for persistent localized disease after treatment, and in three cases for nonresponsive synchronous/metachronous lung nodules while on treatment for stage IV lung cancer. Dense hilar fibrosis was present in all patients. Minimal access surgery was achieved in five cases (video-assisted n = 2, robotic-assisted n = 3). There was no in-hospital mortality. One patient died within 60 days from community-acquired COVID-19 pneumonitis. Seven patients remain free of disease between 5 and 22 months follow-up.
Pulmonary resection is safe and technically feasible following treatment with immune checkpoint inhibitors. Surgical challenges relate to postimmunotherapy fibrosis, but with increased experience and a robotic approach, minimal access surgery is achievable. Further prospective studies are required to assess the surgical impact on disease control and overall survival in this patient cohort.
免疫检查点抑制剂治疗后，挽救性胸部手术在晚期肺癌中的作用尚不清楚。我们报告了 9 例接受派姆单抗治疗后因晚期非小细胞肺癌而行肺切除术的患者系列。
我们对接受派姆单抗治疗晚期肺癌后行肺切除术的病例进行了单中心回顾性分析。符合纳入标准的患者有 9 例。
在 6 例中，手术是由于治疗后局部持续性疾病而进行的，在 3 例中，是由于在治疗 IV 期肺癌时对同步/异时性肺结节无反应而进行的。所有患者均存在致密的肺门纤维化。5 例患者采用微创外科手术（视频辅助 n=2，机器人辅助 n=3）。无院内死亡。1 例患者在 COVID-19 社区获得性肺炎发病后 60 天内死亡。7 例患者在随访 5 至 22 个月时无疾病。
免疫检查点抑制剂治疗后行肺切除术是安全且可行的。手术挑战与免疫治疗后纤维化有关，但随着经验的增加和机器人方法的应用，微创外科手术是可以实现的。需要进一步的前瞻性研究来评估该患者群体中手术对疾病控制和总生存的影响。
