# Salvage Pulmonary Resection After Immune Checkpoint or Tyrosine Kinase Inhibitor Therapy for Initially Unresectable Non-Small-Cell Lung Cancer: A Systematic Review

## TL;DR

This study reviews the outcomes of lung cancer surgery after using drugs to shrink tumors, showing it's a safe and effective option for some patients.

## Contribution

The study is the first systematic review to evaluate the feasibility and outcomes of salvage pulmonary resection after ICI or TKI therapy in advanced NSCLC.

## Key findings

- Salvage pulmonary resection after systemic therapy achieved an R0 resection rate of 93%.
- Short-term survival rates were encouraging, with 68% disease-free and 88% overall survival at one year.
- Major complications occurred in 11% of cases, with a low 30-day mortality rate of 1.3%.

## Abstract

Background and Objectives: 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. Methods: 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. Results: Fourteen observational series (n = 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. Conclusions: 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.