This case series aimed to analyze the outcomes of patients referred for salvage pulmonary resections after treatment with chemotherapy and immunotherapy for previously metastatic or unresectable tumors.

From October 2016, after multidisciplinary board discussion, eight patients (median: 67 years, range: 52–78 years) underwent medical treatment due to advanced-stage diseases (stage cIIIA–cIVa). Four patients underwent cisplatin-based chemotherapy and, due to progression, were moved to an immunotherapy second line (nivolumab: two patients and pembrolizumab: two patients). Instead, four patients underwent combined cisplatin-based chemotherapy and immune checkpoint inhibitors (atezolizumab: two patients and pembrolizumab: two patients). After a multidisciplinary evaluation for salvage surgery, six patients underwent lobectomies, one patient underwent left pneumonectomy, and one patient underwent upper right lobectomy enlarged to the posterior arches of four ribs. The median duration of surgery was 179 minutes (range: 122–246 minutes). At the final pathological stage, three patients showed a complete major response (ypT0 ypN0), one patient was ypT1a ypN0, one ypT3 ypN0, 2 ypT3 ypN1, and one ypT4 ypN0. The hospital length of stay was 6 days (range: 3–23 days). Two patients had a postoperative complication. At the time of follow-up (median: 15.3 months [range: 1–32 months]), six patients were alive without evidence of the recurrence. Two patients died due to recurrence progression (N3 lymph nodes involvement) of the disease after 6 and 32 months.

In stage IIIB–IVA nonsmall cell lung cancer, salvage lung surgeries after chemotherapy and immunotherapy are feasible, with high rates of R0 resection. Surgery can be technically tricky without significant morbidity and encouraging outcomes (even with a short-interval follow-up).

该病例系列旨在分析接受过化疗和免疫治疗的先前转移性或不可切除肿瘤患者转诊进行挽救性肺切除术的结果。

从 2016 年 10 月开始，经过多学科委员会讨论，8 名患者（中位数：67 岁，范围：52-78 岁）因晚期疾病（cIIIA-cIVa 期）接受了药物治疗。四名患者接受了基于顺铂的化疗，并且由于进展，被转移到免疫治疗二线（纳武单抗：两名患者和派姆单抗：两名患者）。相反，四名患者接受了基于顺铂的联合化疗和免疫检查点抑制剂（atezolizumab：两名患者和 pembrolizumab：两名患者）。在对挽救性手术进行多学科评估后，6 名患者接受了肺叶切除术，1 名患者接受了左肺切除术，1 名患者接受了扩大至四根肋骨后弓的右上肺叶切除术。手术的中位持续时间为 179 分钟（范围：122-246 分钟）。在最后的病理阶段，3例患者表现出完全的主要反应（ypT0 ypN0），1例为ypT1a ypN0，1例为ypT3 ypN0，2例为ypT3 ypN1，1例为ypT4 ypN0。住院时间为 6 天（范围：3-23 天）。两名患者出现术后并发症。在随访时（中位数：15.3 个月 [范围：1-32 个月]），6 名患者在没有复发证据的情况下存活。6 个月和 32 个月后，两名患者因疾病的复发进展（N3 淋巴结受累）而死亡。六名患者在没有复发证据的情况下还活着。6 个月和 32 个月后，两名患者因疾病的复发进展（N3 淋巴结受累）而死亡。六名患者在没有复发证据的情况下还活着。6 个月和 32 个月后，两名患者因疾病的复发进展（N3 淋巴结受累）而死亡。

在 IIIB-IVA 期非小细胞肺癌中，化疗和免疫治疗后挽救性肺手术是可行的，R0 切除率高。如果没有显着的发病率和令人鼓舞的结果（即使是短期随访），手术在技术上可能会很棘手。