Role Of Salvage Surgery Research Articles

Characteristics and outcomes of salvage surgery after immune checkpoint inhibitor therapy for initially unresectable non-small cell lung cancer.

Immune checkpoint inhibitors (ICIs) improved the long-term survival outcomes in patients with advanced non-small cell lung cancer (NSCLC), whereas the role of salvage surgery after ICIs was unknown. The object of this study was to investigate characteristics and outcomes of patients who underwent salvage surgery after ICIs. Retrospective chart review was performed on the basis of our multi-institutional database in search of consecutive patients who underwent salvage surgery after ICIs for initially unresectable NSCLC between 2016 and 2022. Patient characteristics, intraoperative findings, perioperative outcomes, histopathological findings, progression-free survival (PFS), and overall survival (OS) were investigated. Fifteen patients with a median age of 71 years were included in the study. The surgical approach was open thoracotomy in 5 and robotic or thoracoscopic surgery in 10 patients. Resection was performed for primary lesions in 8 and metastatic lesions in 7 patients. Postoperative complication was noted in 1 patient with grade 1 phrenic nerve palsy. The median PFS was 47.9 months, and the median OS was not reached. Three-year PFS was 0% in those with metastatic lesions and 87.5% in those with primary lesions (P=0.12). Salvage surgery after ICIs may be associated with low perioperative morbidity and acceptable long-term outcomes in selected patients. Salvage resection of primary lesions may be associated with more favorable PFS than of metastatic lesions.

Survival analysis in high-grade glioma: The role of salvage surgery

ObjectivesThis study addresses the survival of consecutive patients with high-grade gliomas (HGG) treated at the same institution over a period of 10 years. We analyse the importance of associated factors and the role of salvage surgery at the time of progression. MethodsWe retrospectively analysed a series of patients with World Health Organization (WHO) grade III/IV gliomas treated between 2008 and 2017 at Hospital Gregorio Marañón (Madrid, Spain). Clinical, radiological, and anatomical pathology data were obtained from patient clinical histories. ResultsFollow-up was completed in 233 patients with HGG. Mean age was 62.2 years. The median survival time was 15.4 months. Of 133 patients (59.6%) who had undergone surgery at the time of diagnosis, 43 (32.3%) underwent salvage surgery at the time of progression. This subgroup presented longer overall survival and survival after progression. Higher Karnofsky Performance Status score at diagnosis, a greater extent of surgical resection, and initial diagnosis of WHO grade III glioma were also associated with longer survival. ConclusionsAbout one-third of patients with HGG may be eligible for salvage surgery at the time of progression. Salvage surgery in this subgroup of patients was significantly associated with longer survival.

Preoperative prediction model to evaluate salvage surgery in patients with recurrent or second primary oral cavity squamous cell carcinoma

ObjectiveIn approximately 50% of patients with oral cavity squamous cell carcinoma (OCSCC), the disease progresses after curative surgery. However, the role of salvage surgery (SS) is controversial, and life expectancy after SS is unknown. MethodsIn this study, 262 patients with OCSCC with locoregional recurrence and second primary OCSCC were retrospectively enrolled and divided into a resectable (55.0%, 144/262) and unresectable (45.0%, 118/262) groups. After excluding neck recurrence only, SS had been performed 195 times in the resectable group. The corresponding preoperative clinicopathologic factors and postsurgery survival (PSS) of each SS were pooled for analysis. ResultsMedian survival after disease progression was 64.2 and 10.4 months for the resectable and unresectable groups, respectively. In the resectable group, one-fifth (19.5%, 37/190) of the patients died within 1 year of SS (PSS < 1 year), and one-third (32.8%, 64/195) of the patients had undergone SS two or more times. The interval from the last surgery ≤ 12 months, depth of invasion of the last surgery > 1 cm, and clinical evidence of nodal disease at the preoperative evaluation were independent predictors of poor PSS. A scoring prediction model was established with 1 point for each factor. The results revealed 1-year postsurgery death rates of 10.3% in the low-risk group (score: 0–1) and 48.6% in the high-risk group (score: 2 or 3) (P < 0.001). ConclusionsIn conclusion, an effective scoring model predicting life expectancy after SS for patients with OCSCC was established.

Refractory recurrent spinal chondrosarcoma: What is the role of salvage surgery?

BackgroundThe spinal chondrosarcoma has high risk of recurrence if the initial surgery is not performed in an en bloc fashion. It remains technically demanding to surgically manage the refractory recurrent spinal chondrosarcoma (RRSC). This study is to assess the clinical features and investigate the prognostic factors for patients with RRSCs. Methodsforty-nine patients with RRSCs underwent salvage surgeries in our institution, and the clinical characteristics were collected and recorded by two independent reviewers. Univariate and multivariate analyses were performed to investigate the independent prognostic factors of recurrence-free survival (RFS) and overall survival (OS) for patients with RRSCs. ResultsDuring the mean follow-up of 31.7 ± 21.04 months (Range 9–93), the 3-year RFS and OS rate was 24.5% and 34.5%, respectively. According to the Cox proportional hazards regression model, wide excision with tumor-free margin (>4 mm) was associated with both better RFS and OS for patients with RRSCs. Meanwhile, the number of recurrences ≤2 was beneficial to RFS, while high pathological grade was correlated with worse OS. ConclusionsWide excision with tumor-free margin (>4 mm) is recommendable if appropriate in the salvage surgery for patients with RRSCs. Patients with number of recurrences ≤ 2 and lower pathological grade may have better RFS and OS, respectively.

Clinical outcomes, prognosis, and predictors of salvage surgery in oral cavity squamous cell carcinoma.

e18040 Background: Salvage surgery (SS) is one of the curative options for oral cavity squamous cell carcinoma (OCSCC) patients with locoregional recurrence (LRR) or secondary primary, but the role of SS should be reevaluated between life expectancy, morbidity, and quality of life. Selecting suitable OCSCC patients receiving SS is important. Methods: From 2010 to 2018, newly diagnosed OCSCC patients who progressed to LRR or secondary primary were recorded. Clinical outcomes, prognostic factors, and predictors were analyzed for the patients receiving SS. Cox regression analyses were performed for PSS, defined from the date of SS to the date of death or last follow-up. Survival was estimated using the Kaplan–Meier method and log-rank tests. Results: A total of 263 newly diagnosed OCSCC patients progressing to LRR or secondary primary were recorded. Half (55.1%, 145/263) of them received SS, and one-third (29.7%, 43/145) of the SS group received twice and more times SS. Median survivals after disease progression were 65.6 and 10.6 months for patients with or without SS, respectively (P &lt; 0.001). A total of 214 SS events were enrolled for analysis. Nearly twenty percentage (20.1%, 39/194) of SS events would progress to death within 1 year after surgery (PSS &lt; 1 year). PSSs of the first, secondary, third, and fourth or more times SS were 64.2, 47.6, 40.9, and 18.9 months, respectively (P = 0.217). Surgical features of the last surgery (perineural invasion and depth of invasion), the interval between the last and current surgery, and clinical N staging of the current surgery were the four independent factors for PSS. To predict the patients with PSS &lt; 1 year, a scoring system was established that each of the independent factors was scored one point. The area under the curve of the scoring system was 0.755, and sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 76.0%, 39.0%, and 90.8%, respectively (Table). Conclusions: A scoring system with a high negative predictive value was established to predict PSS &lt; 1 year.[Table: see text]

Análisis de supervivencia en gliomas de alto grado: papel de la cirugía de rescate

ObjectivesThis study addresses the survival of consecutive patients with high-grade gliomas treated at the same institution over a period of 10 years. We analyse the importance of associated factors and the role of salvage surgery at the time of progression. MethodsWe retrospectively analysed a series of patients with World Health Organization (WHO) grade III/IV gliomas treated between 2008 and 2017 at Hospital Gregorio Marañón (Madrid, Spain). Clinical, radiological, and anatomical pathology data were obtained from patient clinical histories. ResultsFollow-up was completed in 233 patients with HGG. Mean age was 62.2 years. The median survival time was 15.4 months. Of 133 patients (59.6%) who had undergone surgery at the time of diagnosis, 43 (32.3%) underwent salvage surgery at the time of progression. This subgroup presented longer overall survival and survival after progression. Higher Karnofsky Performance Status score at diagnosis, a greater extent of surgical resection, and initial diagnosis of WHO grade III glioma were also associated with longer survival. ConclusionsAbout one-third of patients with HGG may be eligible for salvage surgery at the time of progression. Salvage surgery in this subgroup of patients was significantly associated with longer survival.

Salvage surgery for advanced non‐small cell lung cancer after targeted therapy: A case series

BackgroundTumor recurrence or residual tumor after targeted therapy is common in patients with advanced non‐small cell lung cancer (NSCLC). There is a lack of high‐level evidence on which type of treatment should be employed for these patients and the role of salvage surgery has not been well reported in the literature.MethodsA retrospective analysis of patients who underwent salvage surgery in our center between January 2016 and June 2019 for advanced NSCLC after targeted therapy was performed.ResultsA total number of nine patients were identified, including five males and four females, with a median age of 56 years (range, 40–65 years), all diagnosed with lung adenocarcinoma stage IIIa–IVb. All patients had received targeted therapy according to individual positive mutation of driver gene(s). Salvage surgery was performed for tumor recurrence or residual tumor after a duration of 2–46 months of targeted therapy. A negative surgical margin was achieved in all cases. Postoperative complication rate was 11.1% (1/9). All patients were alive at the time of this analysis and two patients had disease progression. After a median follow‐up of 17 months (range: 5–44 months), the median event‐free survival and postoperative survival was 14 months (range: 2–44 months) and 17 months (range: 5–44 months) respectively.ConclusionsSalvage surgery may be a feasible and promising therapeutic option for tumor recurrence or residual tumor in advanced NSCLC in selective patients after targeted therapy.Key points Salvage surgery is feasible in selected patients with advanced NSCLC and provides promising survival outcomes after targeted therapy failure.Salvage surgery provides precise molecular and pathological information which is most important for subsequent therapy.

Heterogenous responses to nivolumab in a single metastatic nodule in hepatocellular carcinoma: role of salvage surgery.

A recent report demonstrated immune heterogeneity of hepatocellular carcinoma (HCC) (1). The objective response rates of sorafenib-treated global and Asian patients by nivolumab, the monoclonal antibody to programmed cell death protein-1, were only 14% and 15%, respectively (2,3). However, there is a lack of reports demonstrating the heterogenous responses within single tumor to nivolumab. Here, we show a pathologically confirmed, heterogenous response to nivolumab within a single metastatic tumor from HCC. In these circumstances, surgery can be considered as an option to cure the disease.

The role of salvage surgery with interstitial brachytherapy for the Management of Regionally Recurrent Head and Neck Cancers

BackgroundThe optimal treatment for regional lymphatic recurrences from head and neck cancer has not been fully established. In order to explore the therapeutic benefit of surgical resection and adjuvant brachytherapy, the authors reviewed their experience utilizing interstitial brachytherapy (IBT) at the M. D. Anderson Cancer Center.MethodsA retrospective chart review of the 51 patients who received salvage surgical resection of lymphatic recurrences and adjuvant IBT between 1993 and 2012 at the M. D. Anderson Cancer Center was undertaken. All patients underwent neck dissection with complete resection and intraoperative placement of afterloading brachytherapy catheters. Soft tissue reconstruction was performed as necessary. The technical aspects of IBT were reviewed, and the overall and disease free survival rates and the recurrence rates were determined.ResultsAll patients had received external beam radiation (EBRT) as part of their initial treatment to a median dose of 66 Gy; 40 and 68% of the patients also had a neck dissection or chemotherapy, respectively. The cumulative regional recurrence probability is 28 and 38% at 5 years and 10 years. All of the patients underwent salvage neck dissection and IBT, with 81% also undergoing soft tissue reconstruction. The median dose delivered to the tumor bed was 60 Gy over a median duration of 4.5 days. There were 21 early adverse events, 8 of which were severe, and 19 late adverse events, 6 of which were severe. The most common early and late adverse events due to surgery and brachytherapy were dysphagia (7.1%) and true vocal cord paralysis (17.9%), respectively. There were no perioperative deaths or carotid hemorrhages. Nineteen patients developed recurrence including regional recurrence and distinct metastasis. The median time to recurrence is 130 months using Kaplan-Meier product limit method. The 2-year disease-free survival rate was 58%. The 2-year, 5-year, and 10-year overall survival rates were 69, 56, and 46%, respectively.ConclusionsRegional recurrences in previously irradiated tissues after the definitive treatment of primary head and neck cancers represent a challenging problem. We demonstrated that salvage neck dissection with IBT provided encouraging regional control and survival rates, while maintaining relatively low acute and long-term toxicity rates.

Endoscopic Transsphenoidal Salvage Surgery for Symptomatic Residual Cystic Craniopharyngioma after Radiotherapy.

Objectives Ideal treatment of craniopharyngiomas is still controversial. Radiotherapy (RT) is considered effective for recurrences or after subtotal tumor removal (STR). About 40 to 50% of patients may experience tumor cyst expansion soon after RT; in these cases, the role of salvage surgery is debated. Design Operative video. Setting Tertiary care center. Participants An 11-year-old boy diagnosed with persistent craniopharyngioma. In 2015, the patient underwent right frontotemporal craniotomy for STR at another center, complicated by panhypopituitarism. Two years later, fractionated 54-Gy RT was performed on growing residual tumor. After 3 months, he was admitted to our hospital due to persistent malaise, vomiting, pulsating headache, and epistaxis. Ophthalmologic evaluation evidenced left homonymous hemianopsia. Results A contrast-enhanced magnetic resonance imaging (MRI) showed a 27-mm cystic component enlarging from the cranial end of the persistent craniopharyngioma lesion, extending into the third ventricle. Biventricular hydrocephalus and brain midline shift to the right were present. Compared with the early post-RT MRI, the cystic component of the tumor demonstrated growth. The patient underwent external ventricular drainage placement for emergent treatment of hydrocephalus and endoscopic transsphenoidal surgery. After cystic content drainage, the lesion was completely removed with its capsule. A “gasket seal” technique was performed for skull base reconstruction, with autologous fascia lata, septal bone, and mucoperiosteum from inferior turbinate. Histologic examination confirmed the craniopharyngioma diagnosis. Postoperative MRI showed resolution of the hydrocephalus and complete tumor removal. Conclusion Although shrinkage of cystic components of craniopharyngioma residuals may occur within 5 to 6 months after RT, salvage surgery is indicated in symptomatic patients. The link to the video can be found at https://youtu.be/4x6Qe76bf60 .

The role of human papillomavirus on the prognosis and treatment of oropharyngeal carcinoma.

Human papillomavirus positive oropharyngeal cancer (HPV-positive OPC) is a distinct subtype of head and neck carcinoma (HNC) distinguished from HPV-negative HNC by its risk factor profile, clinical behavior, and molecular biology. Compared to HPV-negative HNC, HPV-positive OPC exhibits significantly better prognosis and an enhanced response to treatment. Recognition of the survival benefit of HPV-positive tumors has led to therapeutic de-intensification strategies aiming to mitigate treatment-related toxicities while maintaining high response rates. In this review, we summarize key aspects of oral HPV infection and the molecular mechanisms of HPV-related carcinogenesis. We review the clinical and molecular characteristics of HPV-positive OPC that contribute to its improved prognosis compared to HPV-negative HNC. We also discuss current and emerging treatment strategies, emphasizing potential mechanisms of treatment sensitivity and the role of therapeutic de-intensification in HPV-positive OPC. Lastly, we examine literature on the management and prognosis of recurrent/metastatic HPV-positive OPC with a focus on the role of salvage surgery in its management.

The role of salvage surgery in oral squamous cell carcinoma

The role of salvage surgery in oral squamous cell carcinoma

Microsurgery role of salvage surgery for squamous cell carcinoma of the oral cavity: experience in the last 10 years

Microsurgery role of salvage surgery for squamous cell carcinoma of the oral cavity: experience in the last 10 years

The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx

The objective of this study was to comprehensively review overall survival, functional outcomes, and prognostic factors in patients who underwent salvage surgery for locally recurrent squamous cell carcinoma of the oropharynx (SCCOP) after initial radiotherapy. The authors retrospectively reviewed 1681 consecutive patients who completed definitive therapy for primary SCCOP and identified 168 patients with locally recurrent SCCOP who underwent salvage surgery (41 patients), reirradiation or brachytherapy (18 patients), palliative chemotherapy (70 patients), or supportive care (39 patients). Twenty-six of 39 patients (67%) developed a second recurrence after salvage surgery. The 3-year overall survival rate for patients who underwent salvage surgery or received reirradiation, palliative chemotherapy, or supportive care were 48.7%, 31.6%, 3.7%, and 5.1%, respectively. For patients who underwent salvage surgery, older age (P=.03), the absence of a disease-free interval (P<.01), and advanced recurrent tumor stage (P=.07) were associated with lower overall survival. Patients with recurrent neck disease (P=.01) and positive surgical margins (P=.04) had higher rates of recurrence after salvage surgery. Postoperative complications occurred in 19 patients (46%), and there were no perioperative deaths. Functionally, 71% of patients demonstrated>or=80% speech intelligibility, 68% were able to tolerate some oral intake, and 87% who required a tracheotomy subsequently were decannulated. Age, disease-free interval, recurrent tumor stage, recurrent neck disease, and surgical margin status influenced overall survival or recurrence rate after salvage surgery for recurrent SCCOP. Although most patients had good functional outcomes, only a select group of patients with recurrent SCCOP achieved long-term survival after salvage surgery.

P2.51. Role of salvage surgery in patients who recurred after interstitial implant therapy for early tongue cancer

P2.51. Role of salvage surgery in patients who recurred after interstitial implant therapy for early tongue cancer

Salvage Surgery Following Downstaging of Unresectable Hepatocellular Carcinoma—A Strategy to Increase Resectability

Surgical resection with complete extirpation of the tumor gives the best chance of a cure for patients with hepatocellular carcinoma (HCC). However, the resectability of HCC at the time of diagnosis is low (10-30%). This article reviews the use of salvage surgery following tumor downstaging to treat unresectable HCC. A Medline search was undertaken from 1966 to 2005 to identify articles using the keywords "liver neoplasm," "hepatocellular carcinoma," "tumor downstaging," and "unresectable." Additional papers were identified by a manual search of the references from the key articles. Eight to eighteen percent of patients with unresectable HCC responded well enough to the initial palliative treatment to downstage HCC to allow salvage surgical resection. The reported five-year survival rate after salvage surgery following tumor downstaging varied from 24.9 to 57%. Although it is still unknown whether the outcome of salvage surgery following tumor downstaging is comparable to those of resectable tumors after primary resection, one clear message is that salvage surgery following tumor downstaging gives good long-term results and the possibility of a cure in a proportion of patients with unresectable HCC. The role of salvage surgery after tumor downstaging in improving disease-free and overall survival in patients with unresectable HCC should be investigated further by prospective randomized controlled trials.

Prognostic factors and role of salvage surgery in chemorefractory ovarian germ cell malignancies: A study in Chinese patients

Background and objectives. The majority of the studies on ovarian germ cell malignancies (OGCMs) focused on combination chemotherapy and fertility sparing surgery in primary treatment. Prognostic factors and the salvage treatment, particularly the role of salvage surgery, for the chemorefractory disease are much less documented. The purpose of this study was to explore the prognostic factors and the role of salvage surgery in Chinese patients with chemorefractory OGCMs. Methods. A total of 34 patients with chemorefractory OGCMs who underwent salvage surgery at Fudan University Cancer Hospital from April 1992 to December 2005 were retrospectively identified and analyzed. Survival was analyzed using the Kaplan–Meier and the statistical significance of various prognostic factors was tested using both the log–rank and the Cox proportional hazards models. Results. The median age of the study patients was 22.76 years. The histological subtypes included 2 dysgerminomas (DSG), 7 immature teratomas (IMT), 22 endodermal sinus tumors (EST) (including 16 pure EST, 3 mixed type with DSG, 3 with EC), 2 embryonal carcinomas (EC) and 1 mixed form (with component of sex cord–stromal tumor). The median follow-up time was 44.09 months (range, 5–164 months). For the entire study population, 1-, 3-, and 5-year survival were 82.35%, 45.64%, and 33.17%, respectively. The 1-, 3-, and 5-year survival in patients who were rendered macroscopically disease-free or had residual disease ≤ 1 cm after surgical salvage were 93.33%, 80.00%, and 60.95%, compared to 68.42%, 21.05%, and 14.04% in those who had postoperative residual disease > 1 cm ( P = 0.0036). Histology (DSG/IMT vs. non-DSG/IMT) ( P = 0.0221), primary and salvage chemotherapy regimen (non-BEP/PVB regimen for primary chemotherapy and BEP/PVB regimen for salvage chemotherapy vs. all other regimens in primary and salvage chemotherapy) ( P = 0.0316), site of chemorefractory disease (retroperitoneal vs. intraperitoneal) ( P = 0.0221), and salvage surgery states (optimal cytoreduction vs. suboptimal cytoreduction) ( P = 0.0036) were significant prognostic factors for survival through univariate analysis. However, site of chemorefractory disease was excluded as an independent prognostic factor according to multivariate analysis. Conclusions. Chemorefractory cases with dysgerminoma or immature teratoma appear to have better outcome than the other subtypes. When offered standard BEP/PVB regimen as salvage chemotherapy, patients with chemorefractory disease after non-BEP/PVB primary chemotherapy have better prognosis. Optimal cytoreduction during salvage surgery does benefit chemorefractory patients.

Metastatic testicular germ cell tumour: the role of salvage surgery.

To assess the clinical characteristics of metastatic testicular germ cell tumour, response to chemotherapy and outcome of salvage surgery for residual mass were analyzed. Patients with complete response were carefully watched. Salvage surgery was performed in 14 patients after chemotherapy. Resected specimens showed 7 necrosis/fibrosis, 5 teratoma, 1 cancer, and 1 benign schwannoma. Only necrosis/fibrosis was found in cases without teratoma in the primary tumour. Existence of teratomatous elements in a primary tumour suggests that cancer or teratoma is present in the residual tumour. Furthermore, tumour reduction rate could not predict their presence in resected specimens.

Primary childhood osteosarcoma: the role of salvage surgery.

The overall results of salvage surgery for lung metastases were evaluated on 174 consecutive patients with primary osteosarcoma below the age of 20, resected in Milan between 1970 and 1988. Seventy-two children treated in the years 1970-1981 were compared with 102 children treated in the years 1982-1988. In the latter period, adjuvant chemotherapy was replaced by neo-adjuvant programs and salvage surgery was applied systematically to all patients with resectable lung metastases through median sternotomy. During the last period, the overall 5 year survival improved significantly from 35% to 58% (P less than 0.001), while the disease free survival rose from 38% to 45% (median 15 vs. 33 months, P = 0.3). The proportion of patients with completely resected lung metastases rose from 17% (7/42) to 55% (27/49), without operative mortality, and the overall survival from detection of lung metastases (including unresected cases) improved from 0 to 28% at 5 years (P less than 0.001). The survival benefit was observed only in the group of children with resected metastases. These data indicate that systematic bilateral pulmonary resection, combined with neoadjuvant chemotherapy, has contributed to improve the final cure rate of childhood osteosarcoma.