Salvage surgery is safe and effective for clinical stage III non-small-cell lung cancer

The utility of surgery for stage III non-small-cell lung cancer (NSCLC) has yet no consensus. Surgery is mainly deployed in a planned multimodality regimen or as a salvage option after definite chemoradiation. We sought to explore outcomes after salvage surgery, planned surgery or oncological treatment alone for clinical stage III NSCLC.

We identified clinical stage III NSCLC from the National Cancer Database between 2010 and 2020. We used timing between radiation and surgical resection to define salvage surgery vs planned surgery. Surgery performed after 3 months following radiation was considered salvage surgery. We performed propensity score matching to match planned surgery and oncologic treatment alone group to salvage surgery to account for patient and clinical characteristics. After matching, we compared their overall survival. Between salvage surgery and planned surgery, we further compared perioperative outcomes (short-term mortality, 30-day readmission and length of stay).

Among 143 299 patients, 692 (0.5%) underwent salvage surgery and 25 598 (17.9%) underwent planned surgery. Median time from radiation to salvage surgery was 118 days. After the propensity score matching, 10-year survival of salvage surgery (34.6%) or planned surgery (34.5%) was higher than oncological treatment alone (16.8%). Thirty-day mortality (2.3% vs 3.1%), 90-day mortality (5.1% vs 6.0%), 30-day readmission (3.3% vs 4.2%) and length of stay (5 vs 5) were similar between salvage and planned surgery.

Salvage surgery conferred better survival than oncologic treatment alone and similar long-term survival and perioperative outcomes with planned surgery. Salvage surgery is a safe and effective option for stage III NSCLC as planned surgery in selected patients.