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.