The role of surgical resection in the management of small cell carcinoma of the lung.

To assess the role of surgical resection in the management of small cell carcinoma of the lung, experience with 118 patients who were treated between 1973 and 1985 was reviewed. Twenty-five patients underwent surgical resection followed by combination chemotherapy in all except one. The remaining 93 patients were treated by combined chemotherapy and radiation therapy. The 5-year survival rate for patients with stage I disease undergoing surgical resection was 50.8%. For all 25 patients operated on, the 5-year survival rate was 30.7%. In the patients not operated on, only those with complete response had long-term survival, for whom the 5-year survival rate was 11.9%. We consider that surgical resection is definitely indicated in patients with stage I disease. If the response to initial chemotherapy is very good, patients with stage II or T3N0M0 disease also probably should receive resection. Patients with N2 disease are not candidates for resection, unless distant metastases are controlled completely by intensive chemotherapy.