Abstract
Background: Typical carcinoids are low grade malignant neuroendocrine neoplasms, mostly located
centrally in the tracheobronchial tree. The aim of our study was to analyse the long-term
survival and surgical treatment outcome in patients submitted to parenchyma-sparing
resections for typical central carcinoid tumours. Methods: We retrospectively reviewed the data of 70 patients who underwent sleeve resections
or bronchoplastic procedures. We performed 21 sleeve lobectomies, 9 sleeve resections
of the main bronchus, 25 bronchoplasties associated with lung resections and 15 isolated
wedge bronchoplasties. Nine patients (12.8 %) had nodal metastases. Results: There was no operative mortality; postoperative complications occurred in one patient
(1.4 %) who presented an empyema. At long-term follow-up evaluation, we were able
to report good results: all patients were alive and nobody manifested recurrence;
one patient had a late cicatricial bronchial stenosis, which was treated with laser
therapy. Conclusions: This series of central typical bronchial carcinoids, treated with sleeve or bronchoplastic
resection, demonstrated an excellent outcome. Our results suggest that, in experienced
and skilled hands, conservative procedures must be considered the treatment of choice
for the management of these tumours.
Key words
carcinoid tumour - sleeve resection - bronchoplasty
References
- 1
Fink G, Krelbaum T, Yellin A. et al .
Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and
review of 640 cases from literature.
Chest.
2001;
119
1647-1651
- 2
Modlin I M, Sandor A.
An analysis of 8305 carcinoid tumors.
Cancer.
1997;
79
813-829
- 3
Hage R, Brutel de la Riviere A, Seldenrijk C A, Van den Bosch J MM.
Update in pulmonary carcinoid tumors: a review article.
Ann Surg Oncol.
2003;
10
697-704
- 4
Ducrocq X, Thomas P, Massard G. et al .
Operative risk and prognostic factors of typical bronchial carcinoid tumors.
Ann Thorac Surg.
1998;
65
1410-1414
- 5
Travis W D, Rush W, Flieder D B. et al .
Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria
for atypical carcinoid and its separation from typical carcinoid.
Am J Surg Pathol.
1998;
22
934-944
- 6
Filosso P L, Rena O, Donati G. et al .
Bronchial carcinoid tumors: surgical management and long-term outcome.
J Thorac Cardiovasc Surg.
2002;
123
303-309
- 7 Travis W D, Colby T V, Corrin B. Histological Typing of Lung and Pleural Tumours.
3rd edn. Berlin; Springer 1999
- 8 Greene F L, Balch C M, Fleming I D. et al .AJCC Cancer Staging Manual. 6th edn. New
York; Springer Verlag 2002
- 9
El Yamal M, Nicholson A G, Goldstraw P.
The feasibility of conservative resection for carcinoid tumours: is pneumonectomy
ever necessary for uncomplicated cases?.
Eur J Cardiothorac Surg.
2000;
18
301-306
- 10
Skuladottir H, Hirsch F R, Hansen H H, Olsen J H.
Pulmonary neuroendocrine tumors: incidence and prognosis of histological subtypes.
A population-based study in Denmark.
Lung Cancer.
2002;
37
127-135
- 11
Kurul I C, Topςu S, Tastepe I, Yazici U, Altinok T, Cetin G.
Surgery in bronchial carcinoids: experience with 83 patients.
Eur J Cardiothorac Surg.
2002;
107
883-887
- 12
Chughtai T, Morin J, Sheiner N, Wilson J, Mulder D.
Bronchial carcinoid twenty years experience defines a selective surgical approach.
Surgery.
1997;
122
801-808
- 13
McCaughan B C, Martini N, Bains M S.
Bronchial carcinoids. Review of 124 cases.
J Thorac Cardiovasc Surg.
1985;
89
8-17
- 14
Rea F, Binda R, Spreafico G, Calabrò F. et al .
Bronchial carcinoids: a review of 60 patients.
Ann Thorac Surg.
1989;
47
1410-1414
- 15
Massard G, Ducrocq X, Thomas P, Fuentes P, Wihlm J M.
Typical carcinoid tumors of the bronchi: an update.
J Cardiovasc Surg.
2002;
43
16-21
- 16
Rea F, Rizzardi G, Zuin A. et al .
Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience
with 252 patients.
Eur J Cardiothorac Surg.
2007;
31
186-191
- 17
Wilkins Jr E W, Grillo H C, Moncure A C, Scannell J G.
Changing times in surgical management of bronchopulmonary carcinoid tumor.
Ann Thorac Surg.
1984;
38
339-344
- 18
Rea F, Loy M, Bortolotti L, Feltracco P, Fiore D, Sartori F.
Morbidity, mortality, and survival after bronchoplastic procedures for lung cancer.
Eur J Cardiothorac Surg.
1997;
11
201-205
- 19
Deslauriers J, Gregoire J, Jacques L F, Piraux M, Guojin L, Lacasse Y.
Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival
and sites or recurrences.
Ann Thorac Surg.
2004;
77
1152-1156
- 20
Kotoulas C, Lazopoulos G, Foroulis C, Kostantinou M, Tomos P, Lioulas A.
Wedge resection of the bronchus: an alternative bronchoplastic technique for preservation
of the lung tissue.
Eur J Cardiothorac Surg.
2001;
20
679-683
Prof. MD Federico Rea
Division of Thoracic Surgery
Cardiologic, Thoracic and Vascular Sciences
Via Giustiniani, 2
35128 Padova
Italy
Phone: + 39 4 98 21 22 37
Fax: + 39 4 98 21 22 49
Email: federico.rea@unipd.it