Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients.
OBJECTIVE
To evaluate type of surgery, long-term survival and factors influencing outcome in pulmonary carcinoid tumors.


METHODS
We reviewed data of 252 patients who underwent surgery for carcinoid tumor in 1968-1989 (Group A) and in 1990-2005 (Group B). All cases were reviewed and classified as typical (TC) or atypical carcinoid (AC) according to WHO criteria (1999).


RESULTS
There were 174 (69%) patients with TC (167 N0, 6 N1 and 1 N2) and 78 (31%) with AC (56 N0, 13 N1, 9 N2). Surgery consisted of 163 (64.7%) formal lung resections (121 lobectomies, 18 bilobectomies, 14 segmentectomies, 10 pneumonectomies), 76 (30.1%) sleeve or bronchoplastic resections and 13 (5.2%) wedge resections. No perioperative mortality occurred, 17 (6.7%) patients experienced complications. Overall 5, 10 and 15-year survival rate was 90%, 83% and 77%. TC showed a more favourable prognosis than AC (10-year survival rate 93% and 64%; p=0.00001) as well as N0 patients in comparison with N1-2 patients (10-year survival rate 87% and 50%; p=0.00005). Group A received lymph-node sampling, Group B received a systematic lymphadenectomy. No difference was found between Group A and B in detection of nodal metastases (10.9% versus 11.9%; p=0.79), but in Group A we observed 2 lymph-node relapses. In Group B number of sleeve resections significantly increased (2.7% versus 20.4%; p=0.0001) and number of pneumonectomies showed a significant reduction (7.2% versus 1.4%; p=0.01).


CONCLUSIONS
Typical histology and N0 status were important prognostic factors in carcinoid tumors. Parenchyma-sparing procedures must be considered the treatment of choice with systematic lymphadenectomy.
Rea
Federico
F
Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy. federico.rea@unipd.it
Rizzardi
Giovanna
G
Zuin
Andrea
A
Marulli
Giuseppe
G
Nicotra
Samuele
S
Bulf
Renato
R
Schiavon
Marco
M
Sartori
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001984:Bronchial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002276:Carcinoid Tumor / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome