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

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two randomized control studies have examined the efficacy of surgery in SCLC, and both yielded negative results and are out of date.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.