Surgical intervention for small-cell lung cancer: what is the surgical role?

Abstract

Small-cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma that accounts for approximately 10–15 % of all lung cancer cases. This histological subtype is a distinct entity with biological and oncological features differing from non-small cell lung cancer (NSCLC). Treatment is mainly performed using systemic chemotherapy, although surgery in association with chemotherapy may be indicated for a minor proportion of limited-disease cases. Since the outcomes after surgical intervention in patients with very early disease are comparable to those for NSCLC, accurate clinical staging is required, particularly in terms of nodal involvement. In addition to conventional mediastinoscopy, positron emission tomography-computed tomography and endobronchial ultrasonography guided transbronchial needle aspiration have recently become available for node diagnosis. The significance of surgery for SCLC includes local disease control and treatment for cases showing mixed histology. However, only two randomized control studies have examined the efficacy of surgery in SCLC, and both yielded negative results and are out of date. We review herein several studies concerning surgery for SCLC and discuss the results from a practical standpoint. A prospective trial performed in collaboration with pulmonologists is required to address the significance of surgery, which is a limited option in the treatment of SCLC.

New insights into stage and prognosis in small cell lung cancer: an analysis of 968 cases

“…SCLC accounts for 10-15% of all lung cancers (2). In 2011, according to the Surveillance, Epidemiology, and End Results program (SEER), 5-year survival rate was 6.5% for patients with SCLC and 22.1% for those with non-small cell lung cancer (NSCLC) (3).…”

“…In 2011, according to the Surveillance, Epidemiology, and End Results program (SEER), 5-year survival rate was 6.5% for patients with SCLC and 22.1% for those with non-small cell lung cancer (NSCLC) (3). This poor prognosis reflects the rapid growth of SCLC, its propensity for spread to lymph nodes and distant organs, and the higher proportion of advanced diseases at diagnosis (2).…”

Retrospective study of surgery versus non‐surgical management in limited‐disease small cell lung cancer

“…These studies have also reported that multidisciplinary treatment involving chemotherapy and surgery achieved a favorable prognosis in the SCLC patients without mediastinal lymph node metastasis, thus suggesting the importance of surgery. In the majority of published studies, survival benefit related to surgery was limited to stage I and II disease . These data suggest that improved local control may be translated into prolonged survival in selected limited stage SCLC patients.…”

Retrospective study of surgical resection in the treatment of limited stage small cell lung cancer

“…Thus, the implication of previous studies should be carefully considered in terms of current SCLC management. Subsequent investigators have asserted the value of surgery in SCLC . One British centre reported survival rates of 52% at five years among patients undergoing complete resection for stage I‐III SCLC, and a prospective cohort study found that surgery significantly improved median survival in patients with stage I disease, when compared with patients undergoing medical therapy …”