title: Carcinoid tumours of the lung and the 'PEPPS' approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery.
abstract: BACKGROUND
  Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking.
  
  
  METHODS
  In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival.
  
  
  RESULTS
  132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups.
  
  
  CONCLUSIONS
  After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the Ludwig Maximilian University , Munich , Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Neuberger
authors.affiliation: Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University , Munich , Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.affiliation: Institute for Biometry and Epidemiology and the Tumor Registry Munich, Grosshadern Medical Center, Ludwig Maximilian University , Munich , Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Center for Pneumology, Asklepios Clinic Munich-Gauting, Ludwig Maximilian University , Munich , Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gesierich
authors.affiliation: Center for Pneumology, Asklepios Clinic Munich-Gauting, Ludwig Maximilian University , Munich , Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Reichenberger
authors.affiliation: Institute for Pathology, Asklepios Biobank for Lung Diseases, Asklepios Clinic Munich-Gauting , Munich , Germany.
authors.forename: Alicia
authors.initials: A
authors.lastname: Morresi-Hauf
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the Ludwig Maximilian University , Munich , Germany ; Center for Thoracic Surgery, Asklepios Clinic Munich-Gauting, Ludwig Maximilian University, Munich, Germany ; Comprehensive Pneumology Center (CPC) and Member of the German Center for Lung Research, Munich, Germany.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Hatz
authors.affiliation: Center for Thoracic Surgery, Asklepios Clinic Munich-Gauting, Ludwig Maximilian University, Munich, Germany ; Comprehensive Pneumology Center (CPC) and Member of the German Center for Lung Research, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lindner
keywords: Bronchoscopy; Clinical Epidemiology; Equipment Evaluations; Imaging/CT MRI etc; Lung Cancer; Pneumonia; Thoracic Surgery