The widespread adoption of immune checkpoint inhibitors (ICIs) has significantly changed the management of advanced non-small cell lung cancer. However, clinicians often face local recurrence or residual disease after these treatments. A recent multi-institutional study, CReGYT-05, investigated the role of salvage surgery for NSCLC in these complex scenarios. The researchers evaluated 32 patients from 14 centers in Japan who underwent surgical intervention after receiving immunotherapy between 2016 and 2023.

Clinical Outcomes of Salvage Surgery for NSCLC

The study categorized surgical interventions into two main groups: conversion surgery and true salvage surgery. In conversion surgery, clinicians operate on tumors previously classified as unresectable that responded well to systemic therapy. In contrast, true salvage surgery targets local recurrence or residual disease following initial treatment. Notably, the results showed that conversion surgery led to a superior 3-year recurrence-free survival (RFS) rate of 92.8%, compared to just 36.3% for the true salvage group.

Furthermore, the safety profile of these procedures proved encouraging. Approximately 25% of patients experienced perioperative complications, but the study reported no perioperative mortality. Nearly 19% of patients achieved a pathologic complete response (pCR), suggesting that surgery can effectively remove viable tumor cells even in advanced stages. Consequently, clinicians should consider these surgical options for carefully selected patients who respond well to immunotherapy.

Optimizing Patient Selection

Successful outcomes depend heavily on identifying the right candidates for surgical intervention. Univariable analysis in the study identified the type of salvage procedure as a critical factor for long-term survival. Specifically, patients undergoing conversion surgery demonstrated significantly better outcomes than those requiring true salvage surgery for recurrence. Thoracic surgeons and oncologists must collaborate closely to time these interventions appropriately. When significant downstaging occurs, the benefits of salvage surgery for NSCLC become particularly evident.

FAQs

What is the difference between conversion and true salvage surgery in NSCLC?

Conversion surgery involves patients whose tumors were initially unresectable but became operable after a positive response or downstaging to systemic therapy. True salvage surgery addresses local recurrence or residual disease after an initially successful course of non-surgical treatment.

Is salvage surgery safe for patients who have received immunotherapy?

Yes, recent multi-center data suggests that salvage surgery is generally safe with no reported perioperative mortality in the study cohort. While approximately one-fourth of patients may experience complications, the survival benefits, especially for conversion cases, often outweigh the surgical risks.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Tane S et al. Efficacy and Safety of Salvage Surgery After Immunotherapy in Non-small Cell Lung Cancer: A Multi-institutional Retrospective Study. Ann Surg Oncol. 2026 Feb 26. doi: 10.1245/s10434-026-19283-z. PMID: 41746575.

Guerrera F et al. The outcomes of salvage surgery for non-small cell lung cancer after immune checkpoint inhibitor or targeted therapy treatment. A multi-center international real-life study. Eur J Surg Oncol. 2025 Jan 23. doi: 10.1016/j.ejso.2025.109592.

Suzuki S et al. Characteristics and outcomes of salvage surgery after immune checkpoint inhibitor therapy for initially unresectable non-small cell lung cancer. J Thorac Dis. 2024 Sep 24. doi: 10.21037/jtd-24-891.