A Clinico-Pathological Study of Surgical Treatment for Small Cell Carcinoma of the Lung

Thirty-seven patients with histologically confirmed small cellcarcinoma (SCLC), who underwent surgical resection at the NationalCancer Center Hospital between 1963 and 1983, were reviewed.They were divided into two groups, 25 patients who were operatedon between 1963 to 1979 and 12 who were operated on between1980 and 1983. When these two groups were compared, a significantdifference in 5-year survival was found (8% vs 50%). An accumulationof various factors including adjuvant chemotherapy was consideredto contribute to the improvement in survival. After carefullyanalyzing these factors, we have come to the conclusion thatadjuvant chemotherapy was the most important factor among them.An additional six patients with SCLC, who were operated on in1984 and 1985, were also studied. They were either those whowere given an adequate dose of combination chemotherapy beforesurgical resection or those whose local carcinoma which recurredafter complete response was achieved by chemotherapy and/orchest radiation was surgically removed. In two cases, a tumor-likemass which was clearly visible on X-ray film- and in the surgeon'shand at the time of thoracotomy revealed a histo pathological"cure." In another two cases, tissue diagnosis of SCLC whichwas obtained without thoracotomy before chemotherapy and/orradiation was started was reported as NSCLC after the resectedspecimen was histo-pathologically examined. In both of them,the cancer tissue was made up of NSCLC of small cell type. Adiscrepancy between clinical TNM after treatment and pathologicalTNM was noted in two cases. Microinvasion and micrometastases,which were the reasons for the discrepancy, are considered tobe a core of eventual recur rence following induction of completeresponse.