Current Thoracic Surgery

Background: In case of failure or a presence of residual tumor after definitive chemotherapy and/or radiotherapy applied in advanced lung cancer treatment, surgical treatment with R0 resection can be performed in selected patients. Also called salvage resections, the indications for these operations remain unclear in the literature. Our study investigated the efficacy of "Salvage" operations using postoperative survival, intraoperative–postoperative morbidity, and mortality along with prognostic factors.

Materials and Methods: Patients operated on for non-small cell lung cancer between January 2006 and December 2016 were examined. Among these patients, 51 patients who underwent R0 resection after definitive chemotherapy and/or radiotherapy were evaluated.

Results: The mean age was 57.58 ± 6.78 (46-78) years in 46 male and 5 female patients. Thirty-two (62.74%) patients had chemotherapy at the definitive dose, 16 (31.37%) received chemoradiotherapy, 3 (5.88%) underwent high-dose radiotherapy. The mean duration between treatment and surgery was 14 ± 10.89 (6-74) weeks. Thirty-two patients were clinically evaluated as Stage 3A, while 19 as Stage 3B and referred to definitive therapy. Thirty (63%) patients underwent lobectomy and 19 (37%) pneumonectomy. Forty-two patients (82.35%) had no complications, and there were complications in 9 (17.65%) patients. Postoperative mortality occurred in four (7.8%) patients. Five-year survival was calculated as 36.6%, and the median survival was 34 months. Median progression-free survival was 26.23 months.

Conclusion: "Salvage surgery" has been considered a feasible method in experienced centers with acceptable morbidity and mortality in selected patients with advanced lung cancer.