Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Surg Today. 2024 Aug;54(8):917-926. doi: 10.1007/s00595-024-02812-2. Epub 2024 Mar 22.
We evaluated the surgical outcomes of salvage extended surgery after definitive medical treatment with an immune-checkpoint inhibitor (ICI) for locally advanced or unresectable non-small-cell lung cancer (NSCLC).
The subjects of this single-center retrospective analysis were 14 patients who underwent salvage surgery after ICI treatment between May, 2017 and April, 2023 at our institute. We reviewed the comprehensive surgical outcomes, including operative procedures, intraoperative findings, and postoperative morbidities. Overall survival (OS) was calculated using a Kaplan-Meier estimation.
The initial clinical stage before medical treatment (c-stage) was stage III in eight patients, stage IV in five patients, and one patient had postoperative lung cancer recurrence. The indications for surgery were as follows: local control for relapse or residual tumor in ten patients and discontinuation of systemic therapy because of treatment-related complications in four patients. The surgical modes were segmentectomy (n = 1), lobectomy (n = 4), bilobectomy (n = 3), pneumonectomy (n = 6), and bronchoplasty (n = 7). Grade 3 or higher postoperative morbidities were observed in six patients, including only one case of 90-day mortality.
Our series demonstrated that the surgical outcome of salvage extended surgery after ICI therapy may be positive with careful selection of the procedure and indication.
我们评估了免疫检查点抑制剂（ICI）治疗局部晚期或不可切除的非小细胞肺癌（NSCLC）后进行确定性治疗的挽救性扩大手术的手术结果。
本单中心回顾性分析的对象是 2017 年 5 月至 2023 年 4 月在我院接受 ICI 治疗后进行挽救性手术的 14 例患者。我们回顾了综合手术结果，包括手术程序、术中发现和术后并发症。使用 Kaplan-Meier 估计计算总生存期（OS）。
在接受药物治疗前的初始临床分期（c 期）为 8 例 III 期，5 例 IV 期，1 例为术后肺癌复发。手术的指征如下：10 例为局部控制复发或残留肿瘤，4 例为因治疗相关并发症而停止全身治疗。手术方式为肺段切除术（n=1）、肺叶切除术（n=4）、双肺叶切除术（n=3）、全肺切除术（n=6）和支气管成形术（n=7）。6 例患者出现 3 级或更高级别的术后并发症，仅 1 例发生 90 天死亡。
我们的研究表明，在仔细选择手术程序和适应证的情况下，ICI 治疗后进行挽救性扩大手术的手术结果可能是积极的。
