Ueno Tsuyoshi, Yamashita Motohiro, Yamashita Natsumi, Uomoto Masashi, Kawamata Osamu, Sano Yoshifumi, Inokawa Hidetoshi, Hirayama Shin, Okazaki Mikio, Toyooka Shinichi
Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
Department of Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
Gen Thorac Cardiovasc Surg. 2022 Sep;70(9):812-817. doi: 10.1007/s11748-022-01798-3. Epub 2022 Mar 19.
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.
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).
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).
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.
晚期非小细胞肺癌（NSCLC）患者在接受免疫检查点抑制剂（ICI）治疗后进行挽救性肺切除术的安全性尚不清楚。
在这项回顾性多中心研究中，我们回顾了自2017年以来的4年中11例（8例男性，3例女性；中位年龄70岁）因不可切除的NSCLC在ICI治疗后接受挽救性肺切除术患者的围手术期发病率和死亡率。还根据手术时间（>6小时, n = 7；<6小时, n = 4）比较了手术因素。
诊断时的临床分期为IIIA期2例，IIIB期4例，IVA期2例，IVB期3例。8例患者接受帕博利珠单抗治疗，3例接受度伐利尤单抗治疗。2例患者单独接受ICI药物治疗，3例接受放化疗，6例接受化疗。10例行肺叶切除术，1例行双叶切除术。所有患者均实现完全切除。中位手术时间为429（范围169 - 570）分钟，中位失血量为199（范围10 - 5140）毫升。唯一的术中并发症是肺动脉损伤。围手术期发病率和死亡率分别为27%和0%。90天死亡率为9%（1例患者死于间质性肺炎急性加重）。手术时间>6小时的患者在初始诊断时更常出现淋巴结转移（100%对25%，p = 0.02）。
这些患者在ICI治疗后可耐受挽救性肺切除术。初始诊断时的淋巴结转移可能使挽救性手术变得困难。
