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Thorac Cardiovasc Surg 2022; 70(03): 273-276
DOI: 10.1055/s-0041-1730968
Short Communication

Safety Analysis of Salvage Surgery for Advanced Stages or Metastatic Lung Cancers

Luca Bertolaccini 
1   Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milano, Italy
,
Domenico Galetta
1   Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milano, Italy
,
Giulia Sedda
1   Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milano, Italy
,
Filippo de Marinis
2   Department of Oncology, IEO, European Institute of Oncology IRCCS, Milano, Italy
,
Lorenzo Spaggiari 
1   Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milano, Italy
3   Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
› Author Affiliations Funding This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds.
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Abstract

This case series aimed to analyze the outcomes of patients referred for salvage pulmonary resections after treatment with chemotherapy and immunotherapy for previously metastatic or unresectable tumors.

From October 2016, after multidisciplinary board discussion, eight patients (median: 67 years, range: 52–78 years) underwent medical treatment due to advanced-stage diseases (stage cIIIA–cIVa). Four patients underwent cisplatin-based chemotherapy and, due to progression, were moved to an immunotherapy second line (nivolumab: two patients and pembrolizumab: two patients). Instead, four patients underwent combined cisplatin-based chemotherapy and immune checkpoint inhibitors (atezolizumab: two patients and pembrolizumab: two patients). After a multidisciplinary evaluation for salvage surgery, six patients underwent lobectomies, one patient underwent left pneumonectomy, and one patient underwent upper right lobectomy enlarged to the posterior arches of four ribs. The median duration of surgery was 179 minutes (range: 122–246 minutes). At the final pathological stage, three patients showed a complete major response (ypT0 ypN0), one patient was ypT1a ypN0, one ypT3 ypN0, 2 ypT3 ypN1, and one ypT4 ypN0. The hospital length of stay was 6 days (range: 3–23 days). Two patients had a postoperative complication. At the time of follow-up (median: 15.3 months [range: 1–32 months]), six patients were alive without evidence of the recurrence. Two patients died due to recurrence progression (N3 lymph nodes involvement) of the disease after 6 and 32 months.

In stage IIIB–IVA nonsmall cell lung cancer, salvage lung surgeries after chemotherapy and immunotherapy are feasible, with high rates of R0 resection. Surgery can be technically tricky without significant morbidity and encouraging outcomes (even with a short-interval follow-up).

Keywords

surgery - medical treatment - lung cancer - postoperative complication - immunotherapy

Supplementary Material



Publication History

Received: 17 January 2021

Accepted: 19 March 2021

Article published online:
07 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Forde PM, Chaft JE, Smith KN. et al. Neoadjuvant PD-1 blockade in resectable lung cancer. N Engl J Med 2018; 378 (21) 1976-1986
    CrossrefPubMedGoogle Scholar
  • 2 Bott MJ, Cools-Lartigue J, Tan KS. et al. Safety and feasibility of lung resection after immunotherapy for metastatic or unresectable tumors. Ann Thorac Surg 2018; 106 (01) 178-183
    CrossrefPubMedGoogle Scholar
  • 3 Bertolaccini L, Spaggiari L. Salvage pneumonectomy after definitive chemo-radiotherapy. Shanghai Chest 2020; 4: 14
    CrossrefPubMedGoogle Scholar
  • 4 Bertolaccini L, Casiraghi M, Spaggiari L. Immunotherapy in the neoadjuvant settings: a new challenge for the thoracic surgeon?. Interact Cardiovasc Thorac Surg 2020; 30 (01) 1-3
    PubMedGoogle Scholar
  • 5 Jia X-H, Xu H, Geng L-Y. et al. Efficacy and safety of neoadjuvant immunotherapy in resectable nonsmall cell lung cancer: a meta-analysis. Lung Cancer 2020; 147: 143-153
    CrossrefPubMedGoogle Scholar
  • 6 Gentzler RD, Riley DO, Martin LW. Striving toward improved outcomes for surgically resectable non-small cell lung cancer: the promise and challenges of neoadjuvant immunotherapy. Curr Oncol Rep 2020; 22 (11) 109
    CrossrefPubMedGoogle Scholar
  • 7 Cascone T, William WN, Weissferdt A. et al. Neoadjuvant nivolumab (N) or nivolumab plus ipilimumab (NI) for resectable non-small cell lung cancer (NSCLC): clinical and correlative results from the NEOSTAR study. J Clin Oncol 2019; 37: 8504 DOI: 10.1200/JCO.2019.37.15_suppl.8504.
    CrossrefPubMedGoogle Scholar
  • 8 Provencio M, Nadal E, Insa A. et al. Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): an open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol 2020; 21 (11) 1413-1422
    CrossrefPubMedGoogle Scholar
  • 9 Cascone T, Provencio M, Sepesi B. et al. Checkmate 77T: a phase III trial of neoadjuvant nivolumab (NIVO) plus chemotherapy (chemo) followed by adjuvant nivo in resectable early-stage NSCLC. J Clin Oncol 2020; 38: TPS9076
    CrossrefPubMedGoogle Scholar
  • 10 Schanne DH, Heitmann J, Guckenberger M, Andratschke NHJ. Evolution of treatment strategies for oligometastatic NSCLC patients—a systematic review of the literature. Cancer Treat Rev 2019; 80: 101892
    CrossrefPubMedGoogle Scholar
  • 11 Stiles BM, Sepesi B, Broderick SR, Bott MJ. Perioperative considerations for neoadjuvant immunotherapy in non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 160 (05) 1376-1382
    CrossrefPubMedGoogle Scholar