The following is the summary of “Extended resection for potentially operable patients with stage III non–small cell lung cancer after induction treatment” published in the December 2022 issue of Thoracic and cardiovascular surgery by Furrer, et al.
Single or multilevel N2 surgery for locally advanced non-small cell lung cancer is still controversial. Several studies show that if R0 resection is achieved, surgery is beneficial for certain patients. The purpose of this pooled analysis of 3 prospective multicenter trials was to evaluate the resectability and outcome of patients with locally progressed clinical T3/T4 (American Joint Committee on Cancer 8th edition) tumors following induction therapy and surgery. In the Swiss Group for Clinical Cancer Research 16/96, 16/00, and 16/01 studies, 368 patients with stage III non-small cell lung cancer were treated with induction chemotherapy or chemoradiation therapy followed by surgery, including extended resections for 197 patients with T3/T4 disease.
Outcome parameters were analyzed using univariate and multivariate statistical methods. Patients with a median age of 60 were predominantly male (67%). In all, resection was not performed on 38 (or 8.1%) of 197 patients due to technical or medical complications. With a R0 of 80% and a pathological complete response rate of 13.2%, 159 resections were performed, 36 of which were prolonged. No distinction was seen between shorter and longer resections regarding death rates at 30 and 90 days. There was a 32% overall morbidity rate, most of it consisting of rather mild sequelae. Overall survival rates for patients who underwent extensive resections were 61% (95% CI: 43-75), 44% (95% CI: 27-59), and 29.5% (95% CI: 13-48) at 3, 5, and 10 years, respectively.
Overall survival was better after R0 resection (hazard ratio, 0.41; P<.001), but there was no effect of pretreatment N2 extension (177/197) on survival. After induction therapy, there was an 80% R0 resection rate and a 7% 90-day mortality rate following surgery for advanced T3/T4 stage illness, including single and multiple pretreatment N2 disease. It was shown that pretreatment N status did not influence whether or not patients who underwent extended or nonextended resection had a better 5-year survival rate.
Source: sciencedirect.com/science/article/abs/pii/S0022522322004032