title: Equivalent Outcome of Patients with Locally Advanced NSCLC Treated with Salvage Surgery Compared to Induction Chemotherapy Followed by Surgical Resection.
abstract: BACKGROUND
  There have, so far, been few previous reports concerning the use of salvage surgery in small number of patients with primary lung cancer and there are no reports currently available regarding salvage surgery compared to other treatments.
  
  
  METHODS
  The postoperative complications and long-term survival of patients with non-small cell lung cancer (NSCLC) who received salvage surgery compared to induction chemotherapy followed by surgery from 2000 and 2013, were evaluated.
  
  
  RESULTS
  During the study period, 1,847 consecutive patients with lung cancer underwent pulmonary resection at our Institution. Salvage operations were performed in 16 (0.9%) patients. The clinical stages were diagnosed as stage IIB in 1, IIIA in 8, IIIB in 6 and stage IV in 1 patient. The mean interval between initial treatment and surgery was 31.4 months. The surgical procedures were lobectomy in 9, pneumonectomy in 4 and partial resection in 3 patients. The operation was performed during a mean of 303 min; no case required blood transfusion. Complete resection was performed in 81% of the patients. Thus, the morbidity was 31.3% and the mortality rate was 0%. The five-year overall survival (OS) rates in the patients with induction chemotherapy followed by surgery and salvage surgery were 65.2 and 62.2%, respectively, (p=0.460) when OS was calculated from the date of registration to the date of initial treatment. The median survival for patients receiving salvage surgery was 64.4 months at any rate when OS was calculated from the date of registration for initial treatment or surgery.
  
  
  CONCLUSIONS
  Salvage surgery can be performed safely with no mortality and is associated with a reasonable long-term survival, equivalent to the outcome of induction chemotherapy followed by surgical resection.
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan hidetaka@cancer-c.pref.saitama.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Akiyama
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D016879:Salvage Therapy
keywords: LA-NSCLC; NSCLC; prognosis; salvage surgery; surgical resection