Results of emergency salvage lung resection after chemo- and/or radiotherapy among patients with lung cancer

Abstract

OBJECTIVES This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. Materials and Methods We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. RESULTS Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55–70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151–279); median blood loss, 1071.5 ml (IQR 540–1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12–125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3–20.4); and median survival from initial treatment, 19.4 months (IQR 8.0–66.9). CONCLUSIONS Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.

Salvage Surgery for Small-Cell Lung Cancer—A Literature Review

“…The efficacy and safety of salvage thoracic operations have not yet been fully elucidated [ 17 ]. The present definition of salvage surgery for lung cancer is younger than 20 years and refers almost exclusively to non-small cell lung cancer (NSCLC) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], but it is important to underline that the same definition was proposed for and the same procedures were performed in SCLC, as presented above; therefore, the theoretical and practical information is resumed as follows: Salvage surgery for an emergent complication, as a life-saving procedure, performed for an event that occurred during the natural history of the tumor or as a complication during oncological treatment, including SBRT, with curative or palliative intent: massive hemoptysis, lung abscess, empyema, broncho–pleural fistula; Salvage surgery after definitive (full-dose) chemo–radiation therapy/after previous local (SABR) or general treatment (ex. targeted therapy): residual/persistent localized disease, relapsed tumor/recurrence after complete response, cases judged to be contraindicated for chemotherapy or definite radiation therapy due to severe comorbidities, despite a clinical diagnosis of NSCLC stage IIIA, IIIB, or IV disease initially, delayed decision to convert to a trimodal approach; Salvage surgery for progression under chemotherapy; Salvage surgery for oligo-metastatic disease.…”