Leonardi Beatrice, Messina Gaetana, Vicario Giuseppe, Pica Davide Gerardo, Di Filippo Vincenzo, Vinciguerra Riccardo, Capasso Francesca, Caputo Alessia, Giorgiano Noemi Maria, D'Agostino Anna, Iovine Angela, Guarino Alessia Angela, Robustelli Martina, Corte Carminia Maria Della, Morgillo Floriana, Varriale Elisa, Capaccio Damiano, Grimaldi Antonio, Franco Renato, Lucà Stefano, Vicidomini Giovanni, Fiorelli Alfonso
Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Oncology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Thorac Cancer. 2025 Aug;16(16):e70151. doi: 10.1111/1759-7714.70151.
Patients with advanced lung cancer are candidates for systemic therapies. In the context of improved tumor responses and prolonged survival periods, the treatment of tumor/therapy-related complications must be taken into account. Rescue surgery consists of a surgical resection without oncologic purpose but with the aim of controlling an acute and life-threatening complication. We evaluated the postoperative outcomes of patients with advanced stage lung cancer who underwent rescue surgery for tumor or therapy-related life-threatening complications. We conducted a systematic review of literature using PubMed, Scopus, Embase, and Google Scholar using following keywords: ("rescue surgery" or "salvage surgery" or "salvage lung resection") and ("lung cancer" or "non-small cell lung cancer" or "NSCLC" or "SCLC"). The primary outcome was overall survival. Secondary outcomes were the morbidity and mortality. Nine articles were included in our review for a total of 64 patients. The most common indications for rescue surgery were lung abscess, post-obstructive pneumonia, hemoptysis, and empyema. The lung resection consisted of lobectomy (n = 31, 48%), bilobectomy (n = 5, 8%), pneumonectomy (n = 11, 17%), sleeve pneumonectomy (n = 15, 23%), sleeve lobectomy (n = 1, 2%), and segmentectomy (n = 1, 2%). The mean overall survival was 12 months; the postoperative complication rate was 51%. No intraoperative deaths were observed. Rescue surgery is feasible for patients with advanced lung cancer and tumor/therapy-related life-threatening complications. Rescue surgery may allow access to ulterior systemic therapies; but the risk-benefit imbalance should always be taken into account, considering this as a last resort treatment.
晚期肺癌患者适合进行全身治疗。在肿瘤反应改善和生存期延长的背景下，必须考虑肿瘤/治疗相关并发症的治疗。挽救性手术是指无肿瘤治疗目的但旨在控制急性且危及生命的并发症的手术切除。我们评估了因肿瘤或治疗相关的危及生命并发症而接受挽救性手术的晚期肺癌患者的术后结局。我们使用PubMed、Scopus、Embase和谷歌学术对文献进行了系统综述，使用了以下关键词：（“挽救性手术”或“补救性手术”或“挽救性肺切除术”）和（“肺癌”或“非小细胞肺癌”或“NSCLC”或“SCLC”）。主要结局是总生存期。次要结局是发病率和死亡率。我们的综述纳入了9篇文章，共64例患者。挽救性手术最常见的指征是肺脓肿、阻塞性肺炎、咯血和脓胸。肺切除术包括肺叶切除术（n = 31，48%）、双叶切除术（n = 5，8%）、全肺切除术（n = 11，17%）、袖状肺叶切除术（n = 15，23%）、袖状肺切除术（n = 1，2%）和肺段切除术（n = 1，2%）。平均总生存期为12个月；术后并发症发生率为51%。未观察到术中死亡。挽救性手术对于晚期肺癌和肿瘤/治疗相关危及生命并发症的患者是可行的。挽救性手术可能允许进行后续的全身治疗；但应始终考虑风险效益失衡，将其视为最后的治疗手段。
