Pulmonary resection extends survival in early small cell lung cancer

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Pulmonary resection of small cell lung cancer (SCLC) safely improves long-term survival, notably with early-stage disease, according to a report in the May issue of the Mayo Clinic Proceedings.

Long-term survival in SCLC is poor despite good clinical responses to combination chemotherapy and radiation therapy, the authors explain, with most relapses coming from local recurrences.

Dr. Vidhan Chandra and colleagues from the Mayo Clinic College of Medicine, Rochester, Minnesota investigated the postoperative outcomes of 77 patients who underwent surgery for SCLC.

Curative resection was done in 46 patients (60%), the authors report. There were only two perioperative deaths -- one from pulmonary embolism and another from unknown causes. A total of 19 patients had complications, including atrial arrhythmia, pneumonia, and persistent air leaks.

After a median follow-up of 19 months, the results indicate, 20 patients were still alive. Excluding the 10 patients who only underwent biopsy, the estimated 5-year survival was 36% for patients with stage I disease, 40% for stage II patients, 17% for stage III patients, and 0% for stage IV patients.

Median survival was higher for patients who underwent curative surgery (25 months) than for patients who had a palliative procedure (16 months), the researchers note.

"Although we were unable to demonstrate that pulmonary resection significantly influenced survival," the investigators write, "our patients survived longer when curative pulmonary resection was performed. Our inability to show a statistically significantly difference is likely because of the limited number of patients."

In a multivariable analysis, only postsurgical tumor stage (III/IV versus I/II) significantly predicted survival.

"Pulmonary resection in patients with stage I or stage II SCLC is safe with low mortality and morbidity," the authors conclude. "Curative resection is associated with long-term survival in early stage SCLC and should be considered in selected patients."