Salvage Surgery Following Systemic Therapy in Initially Unresectable Non-Small Cell Lung Cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Evaluating salvage pulmonary surgery for initially unresectable non-small cell lung cancer (NSCLC) after systemic therapy.
• Assessing safety, long-term survival, and prognostic factors.
• Focus on patients who did not initially meet criteria for resection.

Purpose of the Study:

• To determine the safety and efficacy of salvage pulmonary surgery in advanced NSCLC.
• To identify factors influencing survival outcomes after neoadjuvant systemic therapy and resection.
• To establish the prognostic value of histology in this patient cohort.

Main Methods:

• Retrospective review of 32 NSCLC patients undergoing curative-intent pulmonary resection post-systemic therapy (2014-2024).
• Primary endpoint: Overall Survival (OS); Secondary endpoints: Recurrence-Free Survival (RFS), major morbidity, R0 resection rate.
• Kaplan-Meier analysis and log-rank tests were used for survival assessments.

Main Results:

• Distant metastasis was the most common reason for initial unresectability (62.5%).
• R0 resection achieved in 81.3%; major morbidity was low (3.1%) with no 90-day mortality.
• Median follow-up: 40.1 months; 5-year OS: 75.0%, 5-year RFS: 46.3%.
• Adenocarcinoma histology was significantly associated with better prognosis (88.9% vs. 35.7%, p=0.003).

Conclusions:

• Salvage pulmonary surgery is a safe and effective option for carefully selected advanced NSCLC patients.
• A 5-year overall survival rate of 75% highlights the potential benefit of this approach.
• Adenocarcinoma histology is a key factor associated with superior outcomes in this setting.