Objective: We analyzed our experience in the period January 1975-Decem
ber 1995 aiming to confirm the role of surgery in the multimodality tr
eatment of small cell lung cancer (SCLC). Methods: 127 patients (5.28%
of the overall lung resections for carcinoma) underwent surgery for S
CLC. The median age was 60 years (range 34-73). In 87 patients (68.5%)
a pre-operative tissue diagnosis was effected and those patients unde
rwent a complete staging procedure. Fifteen patients received up to si
x complete courses of neoadjuvant and adjuvant chemotherapy. The surgi
cal procedures included: 50 pneumonectomies, 71 lobectomies and six we
dge resections. Two patients experienced a local recurrence and a comp
letion pneumonectomy was performed. Results: The median follow-up is 6
6 months (range 6-214). The 5-year actuarial survival rate is 22.6% (m
edian 18 months). Twenty-three patients are still alive, 21 of them be
ing disease-free. Considering the most conspicuous group of patients (
n = 92) treated by surgery and adjuvant chemotherapy, the survival dat
a were 47.2, 14.8 and 14.4% for Stage I, II and III, respectively (P =
0.001). N0 patients had a significantly better survival than N1 and N
2 patients (P = 0.035). Conclusions: Surgery and adjuvant chemotherapy
might represent an effective form of treatment of limited SCLC withou
t lymph-node involvement. The role of surgery is yet to be verified as
regards N1 and N2 status, where even neoadjuvant chemotherapy has not
achieved the hoped-for results (no patient reaching a 2-year survival
). (C) 1997 Elsevier Science B.V.