[Salvage Surgery for Residual and Recurred Tumor after Definitive Chemoradiotherapy]

Standard treatment for clinical N2-locally advanced lung cancer is definitive chemoradiotherapy (CRT). For local recurrence or residual tumor after definitive CRT, salvage surgery may have effective treatment option with relatively high operative risk.

To examine the prognosis and risk of salvage surgery.

In 2001 to 2016, postoperative complications, overall survival and relapse free survival rate were examined in 17 patients who underwent salvage surgery after definitive CRT for clinical N2 or more primary lung cancer.

Median observation period 26.4 months, male 15 female 2, average age 58.6 years. This was 0.6% of 2,630 anatomical resections during this period. Average dose of radiation was 63.5 Gy. Median period from initial treatment to surgery was 16.0 months.15 lobectomy and 2 pneumonectomy. Average operation time was 289 minutes;blood loss was 271 ml. Bronchial stump coverage was performed in all cases, using 10 pericardial fat, 5 omentum, 2 intercostal muscle. Median of postoperative hospital days was 10. There was no perioperative and in-hospital death, but complications occurred in 6 cases (35.3 %). For a prolonged air leakage and 2 anastomotic fistula, 3 reoperations were needed( 17.6%). 5-year overall survival rate was 80.7%, and 5-year relapse free survival rate was 51.0%.

Salvage surgery for clinical N2 lung cancer has a high frequency of postoperative complications and becomes a patient's burden. Salvage surgery seems to be meaningful, but physicians should have sufficient knowledge and experience in conducting this treatment approach.