The Role of Surgery in the Treatment of Limited Disease Small Cell Lung Cancer: Time to Reevaluate

Abstract

Chemo-radiation is considered the standard procedure for the management of limited disease small-cell lung cancer (SCLC). Controversy remains as to when surgery should be considered. We sought to determine the survival after complete resection of SCLC and the prognostic impact of clinical and pathologic stage. A retrospective review was undertaken of patients who underwent surgery between 1980 and 2006. Patients were staged according to the 6th edition of the Tumor, Node, Metastasis classification of lung cancer, actuarial survival estimated with Kaplan Meier methods and comparisons were undertaken using Cox regression. We identified 59 patients who underwent complete resection with nodal dissection for SCLC. The mean age (SD) was 62 (11) years and 41 (69%) were men. Clinical staging information was available in 53, listed by stage with IA (n = 9), IB (n = 21), IIA (n = 0), IIB (n = 13), IIIA (n = 9), IIIB (n = 1). The median time to follow-up (1st to 3rd quartile) was 2.8 (0.79-8.65) years with an overall survival (95% confidence interval) at 1 and 5 years of 76% (65, 88), 52% (40, 68). There were no clear differences in the survival of patients in clinical T categories (p = 0.366) with good overall results in patients across the spectrum of nodal disease from N0 to N2 (p = 0.498). This study shows excellent survival for stage I to III patients who underwent lung resection with nodal dissection for SCLC and supports the need to reevaluate surgery as primary treatment and use of clinical Tumor, Node, Metastasis criteria in the selection of patients with very limited disease for surgery.