The value of completion residual lung resection in ipsilateral recurrent non-small cell lung cancer

Yong Yang; Yichao Wang; Ziwei Wan; Xiong Qin; Yuming Zhu; Bingyong Sheng; Xiaogang Zhao

doi:10.3389/fsurg.2022.990282

The value of completion residual lung resection in ipsilateral recurrent non-small cell lung cancer

Front Surg. 2022 Nov 9:9:990282. doi: 10.3389/fsurg.2022.990282. eCollection 2022.

Authors

Yong Yang¹, Yichao Wang², Ziwei Wan¹, Xiong Qin¹, Yuming Zhu¹, Bingyong Sheng³, Xiaogang Zhao¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Abstract

Background: Recurrence is one of the most important challenges to manage lung cancer. Selected patients might be candidates for resection. This study assessed the outcomes and hazard factors of patients after completion of lung resection for recurrence, focusing specifically on postrecurrence survival (PRS) and overall survival (OS) after surgery.

Methods: This retrospective study enrolled 63 patients who underwent complete pulmonary resection for recurrence between January 2015 and December 2018. Inclusion criteria include potentially curative first resection for primary lung cancer, histologically proven recurrent or new malignancy, and complete pathological report after both operations. PRS and OS were assessed and the influence of patient and treatment features on these endpoints was evaluated.

Results: Most of the patients recurred at stage IIIA, and nearly three-fourth received complete pneumonectomy. The overall 2- and 5-year survival rates were 95% and 75%, whereas the overall 2- and 5-year postrecurrence survival rates were 55% and 36%, respectively. No patient died within 30 or 90 days after completion of residual lung resection, and no serious complications occurred during follow-up. Upon selection of clinically important variables by the Cox proportional hazards regression model, the r-stage [hazard ratio (HR), 3.35; 95% CI, 1.11-10.10; P = 0.03] and stage of primary tumor (HR, 6.26; 95% CI, 2.00-19.55; P < 0.01) were hazard factors for PRS and OS respectively.

Conclusions: Complete pulmonary resection is an acceptable option in selected patients with recurrent lung cancer after surgery. The patients with r-stage earlier than IIIA may benefit from completion pulmonary resection but not IIIB. Completion pneumonectomy failed to significantly prolong the OS. The OS in the enrolled cases was mainly affected by the p-TNM stage assessed by the first resection for primary lung cancer.

Keywords: completion pulmonary resection; lung cancer; outcome; overall survival; postrecurrence survival; recurrence.