Surgery for Small Cell Lung Cancer

Surgery is not a common treatment for people with small cell lung cancer (SCLC), but there are times when it may be an option. It may be an effective treatment for limited-stage small cell lung cancer, depending on the site of the tumors and the extent of the cancer. In fact, surgery could more than double the survival rate for some SCLC patients.

If you are dealing with a SCLC diagnosis and are considering treatment options, ask your doctor about lung cancer surgery. Researching the benefits and understanding the new surgical approaches for SCLC may help you determine the course of treatment that's right for your specific needs and goals.

Surgery Recommendations for SCLC

Surgery is often the preferred treatment for non-small cell lung cancer (NSCLC), the more common type of lung cancer. NSCLC progresses more slowly than SCLC and can possibly be cured through surgery if caught in the early stages.

Small cell lung cancer, on the other hand, grows and spreads much quicker. In 60% to 70% of cases, SCLC has already metastasized, or spread beyond the lungs to other areas of the body, by the time it is diagnosed. This makes surgery less effective.

When Surgery Isn't Recommended

It makes sense to start with those with SCLC who should not have surgery to treat their disease, as they are in the majority.

Small cell lung cancer accounts for around 10% to 15% of lung cancers and is broken down into two stages: limited stage and extensive stage.

By definition, extensive-stage small cell lung cancer is lung cancer that has spread beyond the primary tumor site and is now in the second lung, surrounding lymph nodes, and/or in other parts of the body. The most common sites of lung cancer metastasis include:

At this point, tumors are too large and spread out for surgery to be an effective treatment. It's simply not possible to operate on multiple sites to successfully remove tumors that have spread.

Instead, the first line of treatment for inoperable lung cancer usually combines chemotherapy and immunotherapy, which has been shown to extend life. Radiation therapy may also be used alone or in combination with chemotherapy.

When Surgery May Be Effective

In some instances— fewer than 1 out of 20 patients—SCLC is found when there is one main tumor and cancer hasn't spread to distant lymph nodes or other organs. This is early enough to consider surgery, although it is still considered a controversial treatment option for small cell lung cancer.

Surgery might be the best treatment option if your limited-stage SCLC meets these criteria:

  • One tumor is present in only one lung
  • Cancer is not present in lymph nodes or, if it is, it has only spread to those near the lung with the tumor

Also, with limited-stage small cell lung cancer, surgery is more likely to be an option if the cancer is in the outer parts of the lungs.

In addition to having "good" tumors for surgery, you need to be healthy (aside from the lung cancer) and able to tolerate surgery. The operation puts excessive strain on the body, so a strong heart and overall good health are essential.

Following surgery, your doctor will probably recommend that you undergo chemotherapy, known as adjuvant chemotherapy, to help ensure that all cancer cells have been removed or killed.

Types of Surgery

If it is determined that you are a candidate for surgery, your doctor will discuss what type of procedure is best for removing your cancer and trying to prevent it from recurring.

There are options for the surgical removal of small cell lung cancer tumors. The choice often depends on the location and size of the tumor.

Surgeries for SCLC include:

  • Pneumonectomy: A pneumonectomy involves the removal of an entire lung. This may seem like an extreme procedure, but if you have good lung function with the remaining lung, you can live a full, active life by making some lifestyle adjustments.
  • Lobectomy: A lobectomy removes cancer tumors along with one of the five lobes that make up your lungs. In studies comparing surgeries for SCLC that don't remove an entire lung, a lobectomy showed the best outcome, with better survival rates.
  • Segmentectomy: The lobes of the lung are divided into segments. In this surgery, one or more of these segments are removed along with all cancer cells.
  • Wedge resection: A wedge resection removes the tumor plus a wedge-shape area of surrounding tissue. The procedure is usually limited to small tumors (preferably less than 2 centimeters) that are located on the outer parts of the lungs. Less tissue is lost than in a lobectomy or segmentectomy, but your prognosis is not as good with a wedge resection.
  • Sleeve resection: A sleeve resection is sometimes done as an alternative to a pneumonectomy if tumors surround the airways. Research has shown that this procedure offers outcomes similar to a lobectomy for treating SCLC.

Traditionally, lung surgery required doctors to make a large chest incision and pull back the ribs to remove tumors. A less-invasive option called video-assisted thoracoscopic surgery (VATS)is increasingly used . A few small incisions are made to the chest, then small instruments and a camera are used to remove the malignant tissue. When a VATS is possible, it may result in fewer complications.

Prior to Surgery

If surgery is considered, a very careful evaluation will need to be done to ensure that the cancer is still local and that major surgery will not pose significant risks.

This will include a mediastinoscopy. During this minor procedure, camera scopes are inserted into the chest area between the lungs. Your doctor will be checking to make sure that the cancer has not spread to lymph nodes in this region (N2 lymph nodes). A tissue sample may be taken for analysis.

Sometimes PET/CT scans, which are much less invasive, can be used to make this assessment.

Pulmonary function tests will also be done to make sure that you will tolerate the surgery and have adequate lung function after the surgery.

Your doctor will need to review all medications you are taking (including supplements and vitamins). It may be necessary to stop taking some of your medicines for a period of time prior to surgery.

Smoking Cessation

If you smoke, it's important to quit. Continuing to smoke can lead to surgical complications and reduce your body's ability to heal well; overall, it decreases your chances for a successful outcome from surgery.

There are many other benefits to stopping smoking including improving your survival and lowering the risk that cancer will recur.

After Surgery

While the aim of surgery is to remove all cancerous cells, it's very possible that cancer may have spread beyond the tumors your doctor sees on scans. As a precaution, your doctor will recommend additional treatments to ensure all cancer cells are eliminated. This should reduce your risk of cancer recurring.

Undergoing multiple cycles of chemotherapy after surgery along with chest and cranial radiation therapy has been shown to extend patients' lives. Specifically, incorporating prophylactic cranial irradiation (PCI), a type of radiation designed to help prevent the spread of cancer to the cranial region, may be used to lower the risk of brain metastases.

The risk of brain metastases occurring three years after surgery is estimated to be between 9.7% and 35.4% for limited-stage small cell lung cancer, depending on how advanced the cancer is at the time of diagnosis.

Some patients find that postoperative pulmonary rehabilitation improves lung function and makes a significant difference in the quality of life. The research on this treatment is still being studied, but you may want to discuss the benefits with your doctor to see if it can help you.

Prognosis

Studies suggest that for people with early-stage (limited stage) small cell lung cancers (also designated as T1 or T2), surgery improves survival rate. 

The most effective surgical treatment is a lobectomy, which offers a five-year survival rate of 70%. These findings show a significant improvement in outcomes compared to SCLC patients who do not have surgery and have an overall 5-year survival rate of 31.8%.

Despite these positive studies, there have been other researchers who say that surgery is not more effective than radiation therapy for treating limited-stage SCLC patients.

These differences show that there is no perfect solution and deciding whether or not surgery will benefit you is a personal decision. Gathering all the data and facts is important. So is sitting down with your doctors and loved ones to discuss what you hope to gain from treatment before deciding which options are best for you.

A Word From Verywell

It's important to keep in mind that everyone is different. Some limited-stage small cell lung cancers may be difficult or impossible to treat with surgery due to the location of the tumor. The presence of other medical conditions may also lead to the risk of surgery outweighing the potential benefits.

When deciding whether surgery is the best course for you, you may want to consider getting a second opinion. You can reach out to larger cancer treatment centers for a consultation. In some cases, doctors at these facilities can meet with you remotely, so you may not even need to worry about traveling to get their take on your case.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated?.Cancer. 2010;116(5):1350-7. doi:10.1002/cncr.24853

  2. Maeda R, Yoshida J, Ishii G, et al. Long-term outcome and late recurrence in patients with completely resected stage IA non-small cell lung cancerJ Thorac Oncol. 2010;5(8):1246-50. doi:10.1097/JTO.0b013e3181e2f247

  3. Shirasawa M, Fukui T, Kusuhara S, et al. Efficacy and risk of cytotoxic chemotherapy in extensive disease-small cell lung cancer patients with interstitial pneumoniaBMC Cancer. 2019;19(1). doi:10.1186/s12885-019-5367-0

  4. American Cancer Society. What is lung cancer? Updated October 1, 2019.

  5. Horn L, Mansfield A, Szczęsna A, et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung CancerNew England Journal of Medicine. 2018;379(23):2220-2229. doi:10.1056/nejmoa1809064

  6. American Cancer Society. Surgery for Small Cell Lung Cancer. Updated  October 1, 2019.

  7. Moffitt Cancer Center. Pneumonectomy: Surgery for Lung Cancer. Updated 2018

  8. Liu Y, Shan L, Shen J, et al. Choice of surgical procedure - lobectomy, segmentectomy, or wedge resection - for patients with stage T1-2N0M0 small cell lung cancer: A population-based study. Thorac Cancer. 2019;10(4):593-600. doi:10.1111%2F1759-7714.12943

  9. Yuequan J, Zhi Z, Chenmin X. Surgical Resection for Small Cell Lung Cancer: Pneumonectomy versus Lobectomy. ISRN Surg. 2012;2012:101024. doi:10.5402/2012/101024

  10. Dziedzic D, Orlowski T. The Role of VATS in Lung Cancer Surgery: Current Status and Prospects for DevelopmentMinim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430

  11. Cataldo JK, Dubey S, Prochaska JJ. Smoking cessation: an integral part of lung cancer treatment. Oncology. 2010;78(5-6):289-301. doi:10.1159%2F000319937

  12. Koul PA. Surgery in limited-disease small-cell lung cancer. Lung India. 2012;29(1):2-3. doi:10.4103%2F0970-2113.92345

  13. Zhu J, Bi Y, Han A, et al. Risk factors for brain metastases in completely resected small cell lung cancer: a retrospective study to identify patients most likely to benefit from prophylactic cranial irradiationRadiation Oncology. 2014;9:216. doi:10.1186/1748-717x-9-216

  14. Bryant A, Mundt R, Sandhu A, et al. Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US VeteransAnn Thorac Surg. 2018;105(2):425-431. doi:10.1016/j.athoracsur.2017.07.048

  15. Barnes H, See K, Barnett S, Manser R. Surgery for limited-stage small-cell lung cancer. Cochrane Database Syst Rev. 2017;4:CD011917. doi:10.1002/14651858.cd011917.pub2

Additional Reading