title: Recurrence of pulmonary carcinoid tumors after resection: implications for postoperative surveillance.
abstract: BACKGROUND
  The current guidelines for follow-up care after treatment of non-small cell lung cancer recommend continued surveillance for detection of recurrent or metachronous disease. However, carcinoid tumors, especially those with a typical histologic profile, tend to be less aggressive. Our goal was to determine the patterns of relapse and the manner of detection of recurrences, to guide follow-up care after resection.
  
  
  METHODS
  Patients who underwent operations for pulmonary carcinoids at our institution were identified from a prospectively maintained database, and their medical records were reviewed for relapse patterns, detection methods, and outcomes.
  
  
  RESULTS
  A total of 337 patients who underwent resection between 1993 and 2010 were included, with a median follow-up time of 3.5 years. Typical and atypical carcinoids were present in 291 (86%) and 46 (14%) patients, respectively. Recurrences occurred in 21 patients (6%), with distant metastases in 20 patients (95%) and locoregional recurrence in only 1 patient. Most recurrences (15 [76%]) were not detected through scheduled surveillance imaging but after the presentation of symptoms (7 [33%]) or incidentally by studies performed for unrelated reasons (8 [38%]). The risk of recurrence increased with positive lymph nodes and atypical histologic type. Only 9 of 291 patients (3%) with typical carcinoids experienced recurrences, with a median time to recurrence of 4 years (range, 0.8-12 years). Conversely, 12 of 46 patients (26%) with atypical carcinoids experienced recurrences, with a median time to recurrence of 1.8 years (range, 0.2-7 years).
  
  
  CONCLUSIONS
  After complete resection, scheduled surveillance imaging failed to detect most recurrences. Recurrence was rare in patients with node-negative typical carcinoids. Given the low risk of recurrence and the unclear efficacy of surveillance imaging, routine surveillance imaging may not be warranted in this cohort.
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Feiran
authors.initials: F
authors.lastname: Lou
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Inderpal
authors.initials: I
authors.lastname: Sarkaria
authors.affiliation: Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pietanza
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Travis
authors.affiliation: Department of Pathology, Dong-A University College of Medicine, Busan, Republic of Korea.
authors.forename: Mee Sook
authors.initials: MS
authors.lastname: Roh
authors.affiliation: Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sica
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Healy
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Valerie
authors.initials: V
authors.lastname: Rusch
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: huangj@mskcc.org.
authors.forename: James
authors.initials: J
authors.lastname: Huang
mesh_terms: D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011159:Population Surveillance; D012189:Retrospective Studies
keywords: 11