Rescue Surgery for Advanced Stage Lung Cancer: A Systematic Review.

Abstract

Patients with advanced lung cancer are candidates for systemic therapies. In the context of improved tumor responses and prolonged survival periods, the treatment of tumor/therapy-related complications must be taken into account. Rescue surgery consists of a surgical resection without oncologic purpose but with the aim of controlling an acute and life-threatening complication. We evaluated the postoperative outcomes of patients with advanced stage lung cancer who underwent rescue surgery for tumor or therapy-related life-threatening complications. We conducted a systematic review of literature using PubMed, Scopus, Embase, and Google Scholar using following keywords: ("rescue surgery" or "salvage surgery" or "salvage lung resection") and ("lung cancer" or "non-small cell lung cancer" or "NSCLC" or "SCLC"). The primary outcome was overall survival. Secondary outcomes were the morbidity and mortality. Nine articles were included in our review for a total of 64 patients. The most common indications for rescue surgery were lung abscess, post-obstructive pneumonia, hemoptysis, and empyema. The lung resection consisted of lobectomy (n = 31, 48%), bilobectomy (n = 5, 8%), pneumonectomy (n = 11, 17%), sleeve pneumonectomy (n = 15, 23%), sleeve lobectomy (n = 1, 2%), and segmentectomy (n = 1, 2%). The mean overall survival was 12 months; the postoperative complication rate was 51%. No intraoperative deaths were observed. Rescue surgery is feasible for patients with advanced lung cancer and tumor/therapy-related life-threatening complications. Rescue surgery may allow access to ulterior systemic therapies; but the risk-benefit imbalance should always be taken into account, considering this as a last resort treatment.