Clinical nodal positive disease is associated with greater surgical complexity in salvage lung resection after tyrosine kinase inhibitor therapy.

The technical complexity of salvage lung resection after epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI) therapy remains unclear, in contrast to the well-recognized technical difficulty of salvage surgery after chemoradiotherapy. We retrospectively reviewed 15 patients with Stage IIIB/IV lung cancer who underwent anatomical lung resection after EGFR–TKI therapy and compared perioperative outcomes according to clinical nodal (cN) status (cN − vs. cN+). Although postoperative complication rates were similar, cN+ cases demonstrated greater technical complexity, including longer operative time (median increase, 66%), greater blood loss (median increase, 138%), and more frequently requiring bronchovascular reconstruction (30% vs. 0%). These findings may warrant caution for thoracic surgeons when operating on TKI-treated patients with cN+ disease, even when the primary tumor appears surgically favorable.