Small cell carcinoma of the lung--to operate or not? Surgical experience and results

From 1962 to 1979, out of 549 patients with small cell bronchial carcinoma (= 15% of all bronchial carcinomas) treated in our clinic, 109 (20%) underwent thoracotomy and 94 (17%) resection. The recurrence free 3-year survival rate for resected patients was 22%, and after 5 years 14 of the 94 (15%) were still alive, using absolute numbers including postoperative deaths. From 1962 to 1975 only patients in stages T1 N0 M0 or T2 N0 M0 survived, with one survivor in stage T1 N2 M0. In the period from 1976 to 1979 patients with tumors in more advanced stages were resected: now those with T1 N1 M0, T1 N2 M0 and predominantly with T2 N1 M0 survived, which can be attributed to the effect of more intensive chemotherapy. Sixty-eight percent of the operations were pneumonectomies; the exploratory thoracotomy rate was 14%. Surgical therapy was seen as an integral part of an oncological regime applied in suitable types of tumor. When the tumor was identified only after resection, 3 courses of a combined chemotherapy including cranial radiation were performed, with additional topical radiation in cases of N2 or T3 forms. When the diagnosis was ascertained preoperatively, 2 (to 3) courses of chemotherapy were followed by resection of the entire area affected, and then by a further 2 (to 3) courses of combined chemotherapy with cranial radiation. A prerequisite for resection in these cases was that the tumor had regressed as a result of the first courses of chemotherapy. In cases of initially inoperable tumors, "residual surgery" appears justified if adequate regression occurs as a result of chemotherapy in view of the large number of local recurrences following chemo(/radio-)therapy alone. Palliative resection is not indicated in small cell bronchial carcinomas, nor is surgery indicated in cases of primarily inoperable tumors which do not react to chemotherapy.