[Rescue Resections in Thoracic Surgery for Septic Lung Carcinomas Undergoing Systemic Therapy: a Case Series]

The use of modern systemic therapies, in particular immune checkpoint inhibitors and targeted substances, has significantly improved the prognosis for patients with advanced non-small cell lung cancer (NSCLC). However, with prolonged survival times and more intensive therapy exposure, the risk of severe tumor- or therapy-associated complications also increases. Infectious melting of the primary tumor is an acute life-threatening situation and often prevents the continuation of oncological therapy. The importance of thoracic surgical rescue procedures to control these complications is still unclear and is the subject of controversial debate.

Ten patients with NSCLC who underwent rescue surgery over a period of 3 years due to progressive infectious tumor melting while undergoing systemic therapy were analyzed retrospectively in this case series. The indications, type and timing of previous systemic therapy, extent of surgery, perioperative complications, and postoperative survival were examined.

The cohort comprised 2 women and 8 men with a mean age of 67 years and predominantly advanced tumor stages (IIB-IVB). The rescue operation was performed on average 4.2 months after the start of systemic therapy. In all cases, the indications were progressive infectious melting of the primary tumor with septic constellation, sometimes accompanied by hemoptysis or pleural empyema, after exhausting all conservative options. Open thoracotomies were predominantly performed; the resection spectrum ranged from lobectomies to extended lobectomies to pneumonectomies. R0 resection was achieved in 9 out of 10 cases. In 8 patients, tumor-specific therapy could be resumed after convalescence. The median postoperative survival time was 19 months.

Rescue resections for infectious tumor melting under systemic therapy are technically demanding procedures in critically ill patients and are associated with an increased complication rate. In selected cases, however, surgical control of the infectious focus can help stabilize the patient's clinical condition and enable the resumption of tumor-specific therapy. Such procedures should therefore be considered as an individualized last-resort.