Radical Minimally invasive surgery following immuno-chemotherapy in Initially-unresectable stage IIIB Non-small cell lung cancer

医学 外科 阶段(地层学) 全肺切除术 肺癌 化疗 根治性手术
作者
Hongsheng Deng,Jun Liu,Xiuyu Cai,Jiawei Chen,Gaetano Rocco,René Horsleben Petersen,Alessandro Brunelli,Calvin S H Ng,Thomas A D'Amico,Wenhua Liang,Jianxing He
出处
期刊:Annals of Surgery [Ovid Technologies (Wolters Kluwer)]
卷期号:Publish Ahead of Print 被引量:4
标识
DOI:10.1097/sla.0000000000005233
摘要

Use of neoadjuvant immunotherapy agent in advanced stage NSCLC is controversial. Herein, we aim to report on a case series of successful conversion from initial unresectable stage cIIIB NSCLC to radical minimally invasive surgery through immunochemotherapy; with particular attention given to surgical outcomes and survival benefit of surgery.Fifty-one patients with initial stage cIIIB NSCLC who received PD-1 agents plus platinum-based chemotherapy between May, 2018 to August, 2020 were retrospectively identified. Surgical and oncological outcomes of enrolled patients were collected.Of 31 patients who underwent subsequent resection, 23 (74.2%) patients underwent lobectomy, 1 (3.2%) underwent pneumonectomy, 5 (16.1%) underwent sleeve lobectomy, and 2 (6.5%) with bilobectomy. The median surgical time was 205 minutes (range, 100-520). The average blood loss was 185 (range: 10-1100) ml. Dense adhesions or fibrosis was noted in 15 cases. The median postoperative hospital stay was 6 (range: 3-13) days. No surgical-related mortality was recorded, only 5 patients (16.1%) experienced any postoperative morbidity (no grade 3 complications). Ten patients (32.3%) had major pathological response, with mediastinal down-staging been observed in 22/31 (71.0%) patients. With a median after up of 15.4 months, thirty-one patients that had surgery had relatively longer median DFS/PFS compared to that of either non-responders or responders that without surgery (27.5 vs. 4.7 vs. 16.7 months, respectively).Radical surgery after chemoimmunotherapy in initial unresectable stage IIIB NSCLC seems to be safe with low surgical-related mortality and morbidity, and was favorably associated with longer DFS/PFS compared to those without surgery.
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