Salvage Lung Resections After Definitive Chemoradiotherapy: A Safe and Effective Oncologic Option.

BACKGROUND: Patients with locally advanced, non-small cell lung cancer treated with definitive chemoradiotherapy alone often demonstrate persistent or recurrent disease. In the absence of systemic progression, salvage lung resection post-definitive chemoradiotherapy has been utilized as a treatment option. Given the paucity of data, we sought to evaluate the safety and efficacy of salvage pulmonary resections occurring \u3e90 days post-definitive chemoradiotherapy. METHODS: Retrospective institutional database review identified patients undergoing salvage lung resection at least 90 days after completion of definitive chemoradiotherapy. Primary outcomes evaluated were overall survival and recurrence-free survival. RESULTS: 30 patients met inclusion criteria between January 1, 2004 and December 31, 2015. The median time to surgery post-definitive radiotherapy was 279 days (IQR 168- 474 days). Extended resections were performed in 11 patients (37%). Ottawa IIIA or greater complications occurred in 12 patients (40%). 30-day mortality was 6.7% (2 patients). Median overall survival post-salvage resection was 24 months. The median overall survival for an R1 resection was 5.3 months versus 108 months for an R0 resection (p=0.001). Persistent pN1 CONCLUSIONS: With proper patient selection, salvage lung resections can be performed with acceptable morbidity, mortality, and oncologic outcomes, particularly when a ypN0R0 resection can be achieved by non-extended surgical means