Long-term survival of a poor-risk octogenarian following wedge resection under VATS for small-cell lung cancer: Report of a case

We describe herein the case of an 81-year-old man who has remained disease- free for more than 3 years after undergoing a wedge resection of cStage I s mall-cell lung cancer (SCLC) under video-assisted thoracoscopic surgery (VA TS), with no adjunct chemotherapy or radiotherapy. The patient had compromi sed pulmonary function and was a poor surgical risk. As he could not have e ndured a conventional lobectomy or intensive chemotherapy, a nonanatomical wedge resection of the area of lung involved by the primary tumor was carri ed out under VATS. Cancer cells from the resected tumor were cultured and t he growth characteristics and sensitivity to 12 anticancer drugs were exami ned, The majority of primary cultured cells proliferated in a monolayer, li ke paving stones, resembling the growth pattern of nonsmall-cell carcinoma cells in vitro. The subcultured cells were resistant to most of the drugs, but showed weak sensitivity to cisplatin (CDDP), adriamycin (ADR), and vinc ristine (VCR), Therefore, the patient was discharged with no adjunct postop erative therapy and was followed up at an outpatient clinic. He has remaine d alive and disease-free for more than 3 years. Thus, we considered that pe rforming wedge resection under VATS for a primary tumor could be appropriat e treatment for selected patients with cStage I SCLC in a peripheral region , especially if they are elderly and a poor surgical risk.