Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review
<b>Background and Objectives:</b> Systemic conversion of stage III–IV non-small-cell lung cancer (NSCLC) to a surgically resectable state with immune checkpoint inhibitors (ICIs) or tyrosine kinase inhibitors (TKIs) creates an emerging cohort of candidates for “salvage” pulmonary resecti...
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2025-06-01
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| author | Vasile Gaborean Catalin Vladut Ionut Feier Razvan Constantin Vonica Alaviana Monique Faur Vladut Iosif Rus Calin Muntean |
| author_facet | Vasile Gaborean Catalin Vladut Ionut Feier Razvan Constantin Vonica Alaviana Monique Faur Vladut Iosif Rus Calin Muntean |
| author_sort | Vasile Gaborean |
| collection | DOAJ |
| description | <b>Background and Objectives:</b> Systemic conversion of stage III–IV non-small-cell lung cancer (NSCLC) to a surgically resectable state with immune checkpoint inhibitors (ICIs) or tyrosine kinase inhibitors (TKIs) creates an emerging cohort of candidates for “salvage” pulmonary resection. No comprehensive evidence synthesis has yet evaluated the feasibility, safety, or oncologic value of this strategy. We aimed to systematically review peri-operative and survival outcomes of salvage lung resection following ICI or TKI therapy. <b>Methods:</b> MEDLINE, Embase, and PubMed were searched (inception–1 May 2025). Studies reporting ≥5 adult NSCLC patients who underwent anatomical lung resection after at least one cycle of ICI or TKI were eligible. Two reviewers screened records, extracted predefined variables, and assessed risk of bias with the Newcastle–Ottawa Scale. Pooled proportions were calculated with a random-effects model. <b>Results:</b> Fourteen observational series (<i>n</i> = 312 patients) met inclusion. Median age was 62 years (range 38–81); 58% were male. Lobectomy (63%) and segmentectomy (21%) were most frequent. Video-assisted/robotic approaches were achieved in 48%. The pooled R0 rate was 93% (95% CI 89–97%); pathologic complete response occurred in 27% (95% CI 19–36%). Major complications (Clavien–Dindo ≥ III) were 11% (95% CI 7–16%), and 30-day mortality was 1.3% (95% CI 0–3%). One-year disease-free and overall survival were 68% and 88%, respectively. <b>Conclusions:</b> Current evidence—albeit heterogeneous—indicates that salvage pulmonary resection after modern systemic conversion therapy is technically feasible, associated with acceptably low morbidity, and yields encouraging short-term oncologic outcomes. Prospective, registry-based studies are needed to define selection criteria and long-term benefit. |
| format | Article |
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| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-06-01 |
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| series | Biomedicines |
| spelling | doaj-art-4442073efff94c3389fcd86c34ee89f12025-08-20T04:00:54ZengMDPI AGBiomedicines2227-90592025-06-01137154110.3390/biomedicines13071541Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic ReviewVasile Gaborean0Catalin Vladut Ionut Feier1Razvan Constantin Vonica2Alaviana Monique Faur3Vladut Iosif Rus4Calin Muntean5Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, RomaniaAbdominal Surgery and Phlebology Research Center, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, RomaniaPreclinical Department, Discipline of Physiology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, RomaniaFaculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, 300041 Timişoara, RomaniaFaculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, 300041 Timişoara, RomaniaMedical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania<b>Background and Objectives:</b> Systemic conversion of stage III–IV non-small-cell lung cancer (NSCLC) to a surgically resectable state with immune checkpoint inhibitors (ICIs) or tyrosine kinase inhibitors (TKIs) creates an emerging cohort of candidates for “salvage” pulmonary resection. No comprehensive evidence synthesis has yet evaluated the feasibility, safety, or oncologic value of this strategy. We aimed to systematically review peri-operative and survival outcomes of salvage lung resection following ICI or TKI therapy. <b>Methods:</b> MEDLINE, Embase, and PubMed were searched (inception–1 May 2025). Studies reporting ≥5 adult NSCLC patients who underwent anatomical lung resection after at least one cycle of ICI or TKI were eligible. Two reviewers screened records, extracted predefined variables, and assessed risk of bias with the Newcastle–Ottawa Scale. Pooled proportions were calculated with a random-effects model. <b>Results:</b> Fourteen observational series (<i>n</i> = 312 patients) met inclusion. Median age was 62 years (range 38–81); 58% were male. Lobectomy (63%) and segmentectomy (21%) were most frequent. Video-assisted/robotic approaches were achieved in 48%. The pooled R0 rate was 93% (95% CI 89–97%); pathologic complete response occurred in 27% (95% CI 19–36%). Major complications (Clavien–Dindo ≥ III) were 11% (95% CI 7–16%), and 30-day mortality was 1.3% (95% CI 0–3%). One-year disease-free and overall survival were 68% and 88%, respectively. <b>Conclusions:</b> Current evidence—albeit heterogeneous—indicates that salvage pulmonary resection after modern systemic conversion therapy is technically feasible, associated with acceptably low morbidity, and yields encouraging short-term oncologic outcomes. Prospective, registry-based studies are needed to define selection criteria and long-term benefit.https://www.mdpi.com/2227-9059/13/7/1541salvage surgeryimmune checkpoint inhibitortyrosine kinase inhibitorconversion therapynon-small-cell lung cancer |
| spellingShingle | Vasile Gaborean Catalin Vladut Ionut Feier Razvan Constantin Vonica Alaviana Monique Faur Vladut Iosif Rus Calin Muntean Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review Biomedicines salvage surgery immune checkpoint inhibitor tyrosine kinase inhibitor conversion therapy non-small-cell lung cancer |
| title | Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review |
| title_full | Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review |
| title_fullStr | Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review |
| title_full_unstemmed | Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review |
| title_short | Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review |
| title_sort | salvage pulmonary resection after immune checkpoint or tyrosine kinase inhibitor therapy for initially unresectable non small cell lung cancer a systematic review |
| topic | salvage surgery immune checkpoint inhibitor tyrosine kinase inhibitor conversion therapy non-small-cell lung cancer |
| url | https://www.mdpi.com/2227-9059/13/7/1541 |
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