Salvage surgery after epidermal growth factor receptor tyrosine kinase inhibitor therapy for non-small cell lung cancer: a focused narrative review.

[OBJECTIVES] The aim of this review was to clarify the differences in therapeutic intent and indications for salvage surgery following treatment with epidermal growth factor receptor tyrosine kinase inhibitor versus definitive chemoradiotherapy. Unresolved issues in molecular targeted therapy, including the optimal surgical procedure, timing of surgical intervention, and the relationship between surgery and radiotherapy, were examined to provide practical guidance for integrating systemic and local treatment in advanced lung cancer.

[METHODS] This focused narrative review was developed by conducting a targeted PubMed search through October 2025 using terms associated with epidermal growth factor receptor, tyrosine kinase inhibitors (TKIs), and salvage or conversion surgery. Relevant studies were selectively examined to explore indications, patient selection, timing of surgery, extent of resection, and comparisons with radiotherapy as an alternative local treatment.

[RESULTS] Salvage surgery following definitive chemoradiotherapy is intended to cure isolated intrathoracic recurrences and typically excludes patients with uncontrolled distant metastases or unresectable lymph node disease. Conversely, salvage surgery following TKI therapy is increasingly included in strategies for systemic disease control. Its objectives include removing local lesions resistant to systemic treatment, prolonging the effectiveness of systemic therapy, and gathering pathological and genomic information. Importantly, the primary therapeutic goal is to prolong overall survival when performed after TKI therapy, rather than improve disease-free survival.

[CONCLUSIONS] As molecular targeted treatments advance, the role of salvage surgery following TKI therapy is expected to expand. Further evidence is required to guide patient selection, timing of intervention, and surgical strategy.