The Peripheral Nodule

This study did not address the peripheral nodule issue. The available literature continues to support surgical treatment of peripheral small cell lung cancer for two reasons. First, an accurate diagnosis is paramount in importance, and this can only be achieved with confidence by surgical resection.

Peripheral small cell lung cancer is sufficiently rare that one should remain skeptical of its existence unless it is proved by resection and submission of the entire specimen for pathologic analysis. Second, peripheral small cell lung cancer appears to be biologically less aggressive than central small cell cancer, and thus lends itself to surgical treatment. Lobectomy is the appropriate operation, extrapolating from the LCSG peripheral nodule study. It is common practice to administer adjuvant chemotherapy after resection of such lesions. However, it is not clear that this is necessary. It is also not likely that this will ever be studied, given the rarity of the lesion. Finally, a functional definition of a peripheral small cell lung cancer is a small cell cancer that presents as such and cannot be diagnosed by bronchoscopy.

Summary

Examination of the surgical literature about small cell lung cancer shows that the subject is more complicated than it seems. It is overly simplistic to regard small cell lung cancer as a nonsurgical disease. The most important principle in dealing with lung cancer is that an accurate diagnosis and stage assignment must be made. Small cell lung cancer is no different from the other histologies in this regard.