Salvage surgery following immunotherapy is a promising treatment option for advanced malignant tumour. However, only a few cases of salvage surgery for malignant pleural mesothelioma (MPM) have been reported. This retrospective study was conducted to assess the feasibility of salvage surgery following immunotherapy for initially unresectabele MPM. Among 61 patients who received pleurectomy/decortication (P/D) for MPM, 7 patients received salvage P/D after immunotherapy. Surgical indication of salvage P/D was conversion to resectability in 5 patients and local relapse in 2 patients, and macroscopic complete resection was achieved in all patients. Although salvage P/D was associated with longer operation time (median, 507 min), higher intraoperative blood loss (median, 2573 mL) and higher morbidity (≥ Grade 3, 29%), no patient died after surgery. Radiographic response to immunotherapy was well correlated with pathologic response, as all 4 patients with partial response showed significant pathologic response (viable cells, ≤ 50%). With the median postoperative follow-up duration of 9.0 months, all patients were alive mostly without tumour recurrence as local recurrence developed in one patient. To conclude, salvage P/D after immunotherapy may be a feasible treatment option for selected patients with advanced MPM, which should be validated in future multi-institutional studies. In addition, a long-term follow-up is essential to reveal clinical benefit achieved with salvage P/D following immunotherapy.

中文翻译：

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恶性胸膜间皮瘤免疫治疗后的挽救性胸膜切除术/去皮质术。

免疫治疗后的挽救手术是晚期恶性肿瘤的一种有前途的治疗选择。然而，仅报道了少数恶性胸膜间皮瘤（MPM）的挽救手术病例。这项回顾性研究旨在评估免疫治疗后对最初不可切除的 MPM 进行挽救手术的可行性。在 61 名因 MPM 接受胸膜切除/去皮质 (P/D) 的患者中，7 名患者在免疫治疗后接受了挽救性 P/D。挽救性P/D的手术指征为5例转为可切除，2例局部复发，所有患者均实现肉眼完全切除。尽管挽救性 P/D 与较长的手术时间（中位，507 分钟）、较高的术中失血量（中位，2573 mL）和较高的发病率（≥ 3 级，29%）相关，但没有患者在手术后死亡。免疫治疗的放射学反应与病理反应密切相关，所有 4 名部分反应的患者均表现出显着的病理反应（活细胞，≤ 50%）。术后中位随访时间为 9.0 个月，所有患者大多存活，无肿瘤复发，一名患者出现局部复发。总之，对于选定的晚期 MPM 患者，免疫治疗后挽救性 P/D 可能是一种可行的治疗选择，应在未来的多机构研究中进行验证。此外，长期随访对于揭示免疫治疗后挽救性 P/D 所取得的临床益处至关重要。