Hamaji Masatsugu, Ozasa Hiroaki, Sakamori Yuichi, Terada Kazuhiro, Yoshizawa Akihiko, Kikuchi Ryutaro, Sakaguchi Yasuto, Sonobe Makoto, Muranishi Yusuke, Miyahara Ryo, Motoyama Hideki, Omasa Mitsugu, Date Hiroshi
Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Kyoto University, Kyoto, Japan.
J Thorac Dis. 2024 Sep 30;16(9):6094-6100. doi: 10.21037/jtd-24-891. Epub 2024 Sep 24.
Immune checkpoint inhibitors (ICIs) improved the long-term survival outcomes in patients with advanced non-small cell lung cancer (NSCLC), whereas the role of salvage surgery after ICIs was unknown. The object of this study was to investigate characteristics and outcomes of patients who underwent salvage surgery after ICIs.
Retrospective chart review was performed on the basis of our multi-institutional database in search of consecutive patients who underwent salvage surgery after ICIs for initially unresectable NSCLC between 2016 and 2022. Patient characteristics, intraoperative findings, perioperative outcomes, histopathological findings, progression-free survival (PFS), and overall survival (OS) were investigated.
Fifteen patients with a median age of 71 years were included in the study. The surgical approach was open thoracotomy in 5 and robotic or thoracoscopic surgery in 10 patients. Resection was performed for primary lesions in 8 and metastatic lesions in 7 patients. Postoperative complication was noted in 1 patient with grade 1 phrenic nerve palsy. The median PFS was 47.9 months, and the median OS was not reached. Three-year PFS was 0% in those with metastatic lesions and 87.5% in those with primary lesions (P=0.12).
Salvage surgery after ICIs may be associated with low perioperative morbidity and acceptable long-term outcomes in selected patients. Salvage resection of primary lesions may be associated with more favorable PFS than of metastatic lesions.
免疫检查点抑制剂（ICI）改善了晚期非小细胞肺癌（NSCLC）患者的长期生存结局，而ICI治疗后挽救性手术的作用尚不清楚。本研究的目的是调查接受ICI治疗后进行挽救性手术患者的特征和结局。
基于我们的多机构数据库进行回顾性病历审查，以寻找2016年至2022年间因初始不可切除的NSCLC接受ICI治疗后进行挽救性手术的连续患者。调查患者特征、术中发现、围手术期结局、组织病理学发现、无进展生存期（PFS）和总生存期（OS）。
15例患者纳入研究，中位年龄71岁。手术方式为开胸手术5例，机器人或胸腔镜手术10例。8例患者对原发性病变进行了切除，7例患者对转移性病变进行了切除。1例患者出现1级膈神经麻痹的术后并发症。中位PFS为47.9个月，中位OS未达到。转移性病变患者的3年PFS为0%，原发性病变患者为87.5%（P=0.12）。
ICI治疗后的挽救性手术可能与围手术期低发病率和选定患者可接受的长期结局相关。原发性病变的挽救性切除可能比转移性病变具有更有利的PFS。
