Few patients with small cell cancer of the lung (SCCL) are treated with pulmonary resection. We reviewed the outcome of surgical resection of SCCL.
From January 1985 through June 2002 all patients who underwent thoracotomy for SCCL at our institution were identified and retrospectively reviewed. All patients were staged using the American Joint Committee on Cancer TNM system.
There were 77 patients (44 men and 33 women). Median age was 65 years (range,35 –85). Operations performed included thoracotomy with biopsy of hilar mass in 10 patients, wedge excision in 30 (6 with talc pleurodesis), segmentectomy in 4, lobectomy in 28, bilobectomy in 3, and pneumonectomy in 2. Mediastinal lymphadenectomy was performed in 50 patients and lymph node sampling in 19. Postoperative therapy included chemotherapy in 20 patients, radiation in 3 and combined chemo/radiation in 40. Median tumor diameter was 4 cm (range,1.0-10.0 cm). Postsurgical tumor stage was IA in 7 patients, IB in 11, IIA in 8, IIB in 7, IIIA in 30, IIIB in 10 and IV in 4. Complications occurred in 19 patients (24.4%) and included atrial arrhythmia in 7 patients, pneumonia in 6, prolonged air leak in 3 and myocardial infarction, postoperative bleeding and stroke in one each. Operative mortality was 2.6%. Follow-up ranged from 4 days to 170 months (median 19 months). At follow-up 20 patients were alive. Estimated overall 5-year survival was 23.4%. 5-year survival for stage I and II combined was 37.5% as compared to 11.8% for stage III and IV combined. Median survival was 23 months. 5-year survival for patients with incomplete resection was 20% compared to 26% for patients with complete resection with curative intent.
Pulmonary resection for patients with stage I or stage II SCCL is safe with low mortality and morbidity. Long term survival in early stage SCCL is good.
Pulmonary resection may have an important role in the treatment of early stage SCCL.
V. Chandra, None.