Small Cell Lung Cancer Surgery: The New Old Way

Background: We present a meta-analysis to assess the importance of surgery in stage I and II small cell lung cancer (SCLC). Today, surgery is recommended by international guidelines only in stage I disease. Mean survival analysis was executed on surgically treated patients and compared with patients that did not undergo any surgery.

Method: A systematic literature search was performed on April 15, 2021, in Medline, Embase, and Cochrane Library databases. Studies published since 2004 on the effect of surgery in SCLC were considered and assessed using ROBINS-I. We preformed I ²-tests, Q-statistics, DerSimonian-Laird tests, Egger-regression, and a post hoc power analysis. The meta-analysis was conducted according to PRISMA standards.

Results: Out of 6,826 records, eight original studies with a total of 12,316 patients (“surgery group”: 3,847 patients; “non-surgery group”: 8,469; treatment period: 1984–2013) were included in this meta-analysis. Heterogeneity between the included studies was revealed and absence of any significant publication bias was found. Patient characteristics did not differ between the “surgery group” and “non-surgery group” (p > 0.05). The mean-survival in an analysis of patients in stage I was 44.2 ± 13.8 months for the “surgery group” and 20.3 ± 5.2 months for the “non-surgery group” (p = 0.0002). The mean-survival in a combined analysis of patients in stage I and II was 38.8 ± 17.9 months for the “surgery group” and 19.8 ± 6.0 months for the “non-surgery group” (p = 0.0026).

Conclusion: Through our meta-analysis we present a significant survival benefit after surgery not only in stage I but also stage II SCLC patients. Both stages should be considered for surgery, which could be the primary treatment in early SCLC. Any nonsurgical treatment in these stages might result in shorter survival time.

Publication History

Article published online:
03 February 2022