SALVAGE SURGERY for stage iii non-small cell lung cancer after final systemic chemotherapy

In oncology, «salvage surgery» on the lungs refers to procedures performed in patients with inoperable or initially metastatic lung cancer after all other treatment options (chemotherapy, radiation therapy, targeted therapy, and 
immunotherapy) have failed. Salvage surgeries are rarely performed in oncological centers. This article discusses the indications for salvage surgery, the optimal scope of intervention, and its outcomes. The authors demonstrate the feasibility of surgical intervention as a salvage treatment for patients with stage III non-small cell lung cancer (NSCLC).The study analyzes data from the literature and presents observations of patients operated on in the Department of Thoracic Oncology at the N.P. Napalkov Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care. Given the lack of prospects for further systemic chemotherapy and the absence of resectability signs, patients underwent salvage surgery. The primary indications for salvage surgery included tumor stabilization, partial disease regression, disease progression, and local recurrence. Most patients underwent an extended lobectomy. Histological examination revealed disease stage reduction and complete tumor cell regression in lymph nodes in some patients. All these patients received immunotherapy in addition to chemotherapy. No tumor cells were found along the resection margins in any of the operated patients (R0). The postoperative 30-day mortality rate was 0%. The median recurrence-free survival (RFS) was 12 months, and the median overall survival (OS) was 18 months. Our findings are comparable to the results of international studies, and in some respects even exceed them, underscoring the validity of performing salvage surgery in patients after definitive systemic chemotherapy when traditional treatment methods are no longer effective. Salvage surgery can increase life expectancy in patients with stage III NSCLC.