Safety and feasibility of lung resection After immunotherapy for metastatic or unresectable tumors Journal Article

Authors: Bott, M. J.; Cools-Lartigue, J.; Tan, K. S.; Dycoco, J.; Bains, M. S.; Downey, R. J.; Huang, J.; Isbell, J. M.; Molena, D.; Park, B. J.; Rusch, V. W.; Sihag, S.; Jones, D. R.; Adusumilli, P. S.
Article Title: Safety and feasibility of lung resection After immunotherapy for metastatic or unresectable tumors
Abstract: Background: Surgeons are increasingly asked to operate on patients with residual disease after immunotherapy. The safety and utility of lung resection in this setting are unknown. Methods: We retrospectively reviewed patients who underwent lung resection within 6 months of treatment with checkpoint blockade agents for metastatic or unresectable cancer. Survival was estimated from the first resection using the Kaplan-Meier approach. Results: Database query identified 19 patients who underwent 22 resections for suspected residual disease with therapeutic intent after immunotherapy between 2012 and 2016. Lung cancer was the most common diagnosis (47%), followed by metastatic melanoma (37%). The most frequently used agents were nivolumab (32%), pembrolizumab (32%), and ipilimumab (16%). Patients received a mean of 21 doses (range, 1 to 70 doses). The final dose was administered at an average of 75 days (range, 7 to 183 days) before the operation. Anatomic resection (lobectomy or greater) was performed in 11 patients (50%). Four lobectomies were attempted minimally invasively, and one required conversion to thoracotomy. Of the resected patients, 68% had viable tumor remaining. R0 resection was achieved in 95%. Mean operative time for lobectomy was 227 minutes (range, 150 to 394 minutes). Complications occurred in 32% of patients; all but 1 were minor (grade 1/2). The 2-year overall and disease-free survival were 77% and 42%, respectively. Conclusions: In patients with previously metastatic or unresectable cancer, lung resection for suspected residual disease after immunotherapy is feasible, with high rates of R0 resection. Operations can be technically challenging, but significant morbidity appears to be rare. Outcomes are encouraging, with reasonable survivals during short-interval follow-up. © 2018 The Society of Thoracic Surgeons
Journal Title: Annals of Thoracic Surgery
Volume: 106
Issue: 1
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2018-07-01
Start Page: 178
End Page: 183
Language: English
DOI: 10.1016/j.athoracsur.2018.02.030
PROVIDER: scopus
PUBMED: 29550207
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    638 Rusch
  2. James Huang
    118 Huang
  3. Bernard J Park
    151 Park
  4. Matthew Bott
    32 Bott
  5. Robert J Downey
    198 Downey
  6. Joseph Dycoco
    22 Dycoco
  7. Manjit S Bains
    219 Bains
  8. David Randolph Jones
    150 Jones
  9. Daniela   Molena
    35 Molena
  10. Kay See   Tan
    68 Tan
  11. James Michael Isbell
    26 Isbell
  12. Smita Sihag
    4 Sihag