Influence of surgical resection prior to chemotherapy on the long-term results in small cell lung cancer. A study of 150 operable patients.

The effect of surgical resection, prior to chemotherapy, on the long-term results obtained in treatment of operable patients with small cell lung cancer (SCC) was evaluated in a consecutive series of 874 patients treated with intensive combination chemotherapy with or without irradiation between 1973 and 1981. Evaluation of disease stage and operability was based on broncho-mediastinoscopy, chest X-ray, bone marrow examination, peritoneoscopy with liver biopsy and lung function tests. The same staging procedures were applied for restaging performed after 18 months of chemotherapy. The series comprised 440 patients with extensive disease and 437 with limited disease of whom 150 were regarded operable. Fifty-four operable patients received no thoracotomy because the treatment policy of SCC did not include surgery at the hospitals from which they were referred. These patients served as a reference with which data on operated patients were compared. Resections were performed in 52 patients while 44 were regarded to be irresectable at the thoracotomy. Thirty-six resections were regarded histologically complete while 16 patients proved to have microscopic (9 pts) or macroscopic (7 pts) residual tumor. The number and per cent of 30 months disease-free survivors in the various categories of the 874 patients were as follows: Completely resected, 12/36 patients (33%); Resected with residual tumor, 2/16 (12.5%); Operable but non-operated, 7/54 (13%); Irresectable, 3/44 (6.8%); Non-operable patients with limited disease, 15/284 (5.3%) and with extensive disease, 11/440 (2.5%). The similarity between rates of long-term survival observed in resected patients with residual tumor and operable, non-operated patients suggests that resection, per se, has no significant influence on long-term results in SCC. The relatively high rate of long-term survival in completely resected patients may therefore primarily be a result of early stage disease at the initiation of chemotherapy.