N1 small-cell lung cancer: where should thoracic surgeons dare?

Small cell lung cancer (SCLC) has always been an insidious field for thoracic surgeons, due to unclear possible indications and deceiving results. The majority of studies regarding surgery for SCLC are dated and the poor outcomes obtained have discouraged their continuation. Nevertheless, since platinum-based chemotherapy protocols have been introduced and the use of new technologies, such as PET scan, allowed a more careful and precise staging, new possible indications raised. To date, surgery plays a very marginal role in the treatment of SCLC and major oncological guidelines indicate a resection only in case of a very limited disease (T1–2N0M0), which account for less than 5% of all diagnosed SCLC (1); in this highly selected group of patients, surgery associated with adjuvant therapies bring to an impressive 65% 5-year survival.