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Ann Thorac Surg 2001;71:962-966
© 2001 The Society of Thoracic Surgeons

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Original article: general thoracic

Surgical resection of non–small cell carcinoma after treatment for small cell carcinoma

^a Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

Accepted for publication September 22, 2000.

Address reprint requests to Dr Smythe, The University of Texas M.D. Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, 1515 Holcombe Blvd, Box 109, Houston, TX 77030
e-mail: rsmythe{at}mdanderson.org

Background. Development of non–small cell lung carcinoma (NSCLC) in patients previously treated for small cell carcinoma (SCLC/NSCLC) is well described; however, little is known about clinical outcome.

Methods. A single-institution 20-year review was performed. Patient characteristics and survival for SCLC/NSCLC patients were compared with those for control patients matched for stage, resection, and previous malignancy.

Results. One thousand four hundred four patients with small cell carcinoma were identified, and 29 underwent therapy for metachronous NSCLC: 11 of 29 patients underwent surgical resection, 10 of these 11 (90%) were stage I. Compared with surgically treated stage I NSCLC patients, SCLC/NSCLC patients were more likely to have squamous histology (70% versus 35%, p = 0.026); and subanatomic resection (90% versus 17.4%, p < 0.0005). The SCLC/NSCLC patients had significantly poorer survival when compared with stage I NSCLC patients undergoing any resection (24.53 versus 74.43 months, p = 0.003) and stage I NSCLC patients receiving wedge resection (24.53 versus 58.39 months, p = 0.006). Survival was similar to NSCLC patients with a history of previous treated extrathoracic solid malignancy.

Conclusions. Surgical resection for SCLC/NSCLC patients is feasible, but poorer prognosis is noted when compared with stage-matched control patients. Surgical candidates should be carefully chosen, and alternative local control modalities considered.

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