P1.18-28 Salvage Surgery for Residual Lesion/Local Reprogression After Initial Medical Treatment in Advanced Non-Small Cell Lung Cancer

Abstract

There is no clear definition of salvage surgery, although the numbers of reports according to salvage surgery in non-small cell lung cancer (NSCLC) have been recently increasing. A total of 29 patients underwent lung resection for residual lesion or local reprogression after definitive chemoradiotherapy (median 60Gy) (dCRT) or after systemic chemotherapy (CTx) and/or tyrosine kinase inhibitor (TKI) in our department between January 2005 and March 2019. Among them, the surgeries for small cell lung cancer (6 patients) and post-treatment complications (3 patients) were excluded. We divided the remaining 20 patients into the following two groups: dCRT in 11 patients and CTx/TKI in 9 patients. We evaluated the clinicopathological findings and surgical outcomes in both groups to assess the perioperative safety and survival benefit of these salvage surgeries. The median age was 58 years (range, 38-72) in dCRT (male 7, female 4), whereas the median age was 68 years (range, 49-80) in CTx/TKI (male 3, female 6). The majority of clinical stage before initial treatment was stage III in dCRT (91%). In contrast, that was stage IV in CTx/TKI (56%). The median interval between initial treatment and salvage surgery was 20 months (range, 8-119) in dCRT and 31 months (range 4-93) in CTx/TKI (P = 0.94). There was no significant difference in the proportion of lobectomy/pneumonectomy; 8 patients (73%) in dCRT and 5 patients (56%) in CTx/TKI, respectively (P = 0.64). Combined resection with adjacent organ was required more frequently in dCRT than in CTx/TKI (64% vs 0%, P = 0.005). The median operative time was significantly longer in dCRT compared to CTx/TKI (333 min vs 213 min, P = 0.038). The median blood loss was more in dCRT than in CTx/TKI (220 mL vs 90 mL), but the difference was not statistically significant (P = 0.37). Postoperative complications (≧grade II in Clavien-Dindo classification) were significant more frequently observed in dCRT than in CTx/TKI (46% vs 0%, P = 0.038). Perioperative mortality was 0% in both groups. Three-year overall survival was 71% in dCRT and 58% in CTx/TKI (P = 0.38), and 3-year disease-free survival was 62% in dCRT and 39% in CTx/TKI (P = 0.59), respectively. In both groups, 3-year disease-free survival were significantly worse in patients with ypN positive compared to in patients with ypN negative (in dCRT, 0% vs 76%, P < 0.001; in CTx/TKI, 0% vs 53%, P = 0.017). Although there was limited data, salvage surgery after dCRT or CTx/TKI was associated with acceptable operative mortality and morbidity, and favorable long-term outcomes in highly selected patients. Postoperative N status might potentially be a poor predictive factor for disease-free survival.