Tracheobronchopulmonary Carcinoid Tumors: Analysis of 40 Patients (original) (raw)
Related papers
European Journal of Cardio-Thoracic Surgery, 2007
Objective: To evaluate type of surgery, long-term survival and factors influencing outcome in pulmonary carcinoid tumors. Patients and methods: We reviewed data of 252 patients who underwent surgery for carcinoid tumor in 1968 (Group A) and in 1990. 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 lymphnode 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. #
Surgery in bronchial carcinoids: experience with 83 patients
2010
Objective: With the changing clinical presentation and histopathological pattern, carcinoids are now considered as a distinct and welldefined group in the neuroendocrine tumour scale. Surgery, especially parenchyma-sparing operations, are the treatment of choice for carcinoids. Methods: Over a 25-year period, 83 patients with typical carcinoid tumour underwent thoracotomy on in our institution. The records of the patients were reviewed and the results were evaluated. Results: The diagnosis was made with radiological methods and bronchoscopy. Cough and recurrent pneumonia were the most common symptoms. A variety of surgical procedures were performed. Thirty of the 83 patients underwent tissue-saving operations. Twenty patients underwent bronchotomy excision, eight were managed with sleeve or partial sleeve resective procedures, and two underwent segmentectomy. Conclusions: Conservative surgery is the treatment of choice of carcinoids, which were histologically typical and anatomically endobronchial. Especially for polypoid type carcinoids and for selected cases with sessile type, bronchotomy with simple excision and sleeve resections is a simple and effective method. As these types of operations produce a better functional result, they should be encouraged in these patients. q
Surgical treatment of bronchial carcinoid tumors: A single-center experience
Lung Cancer, 2010
Background: Bronchial carcinoid is an infrequent neoplasm with a neuroendocrine differentiation. Surgical treatment is the gold standard therapy, with procedures varying from sublobar resections to complex lung sparing broncoplastic procedures. This study evaluates the results of surgical treatment of bronchial carcinoids and its prognostic factors. Patients and methods: Retrospective review of 126 consecutive patients who underwent surgical treatment for bronchial carcinoid tumors between December 1974 and July 2007. Results: There were 70 females (55%) and the mean age was 46 years, ranging from 17 to 81 years. Upon clinical presentation, 38 patients (30%) have had recurrent respiratory tract infection, 31 (24%) cough, 16 (12%) chest pain and 25 (20%) were asymptomatic. Preoperative bronchoscopic diagnosis was obtained in 74 cases (58.7%). The procedures performed were: 19 sublobar resections (14,9%), 58 lobectomies (46%), 8 bilobectomies (6.3%), 6 pneumonectomies (4.7%), 2 sleeve segmentectomies (1.5%), 26 sleeve lobectomies (20.6%) and 9 bronchoplastic procedures without lung resection (7.1%). Operative mortality was 1.5% (n = 2) and morbidity was 25.8% (n = 32), including 12 respiratory tract infections and 4 reinterventions due to bleeding (3) and pleural empyema (1). Among the 112 patients available for follow-up, the overall survival at 3, 5 and 10 years was 89.2%, 85.5% and 79.8%, respectively. Five and 10-year survival for typical and atypical carcinoids were 91, 89% and 56, 47%, respectively. Overall disease-free survival at 5 years was 91.9% Statistical analysis showed that overall disease-free survival correlated with histology -typical vs. atypical -(p = 0.04) and stage (p = 0.02). Conclusion: Surgery provides safe and adequate treatment to bronchial carcinoid tumors. Histology and stage were the main prognostic factors.
Surgical management of bronchial carcinoid tumors: 11-year experience
Turkish Journal of Thoracic and Cardiovascular Surgery, 2014
Bu çalışmada, bronşiyal karsinoid tümörlü hastalarda cerrahi tedavi, ameliyat sonrası komplikasyonlar ve uzun dönem sonuçlar sunuldu. Ça lış mapla nı:Ocak 2000-Aralık 2010 tarihleri arasında ameliyat öncesi ve sonrası patolojik olarak bronşiyal karsinoid tümör olduğu doğrulanmış 57 hastaya (34 kadın, 23 erkek; ort. yaş 43 yıl; dağılım 13-83 yıl) akciğer rezeksiyonu uygulandı. Cerrahi tipi, karsinoid tümörün histopatolojik tipi, ameliyat sonrası komplikasyonlar ve uzun dönem sonuçlar değerlendirildi. Bul gu lar: Patolojik muayenede 44 (%77) tipik, 13 (%23) atipik karsinoid tümör saptandı. Hastaların 23'üne (%40.3) bronşiyal sleeve reseksiyon, üçüne (%5.2) pnömonektomi, 27'sine (%47.3) lobektomi, dördüne (%7) sublobar rezeksiyon uygulandı. Sekiz hastada (%14) ameliyat sonrası komplikasyon gözlendi. Ameliyat sırası mortalite gözlenmedi. Takip döneminde hiçbir hastada ölüm ve lokal nüks olmadı. So nuç: Parenkim koruyucu rezeksiyonlar (sleev lobektomi ve sleev bronşiyal rezeksiyon), tipik karsinoid tümörlü hastalarda, negatif cerrahi sınır elde etmek koşulu ile uzun dönem takip sürecinde iyi prognoz sağlayabilir. Anah tar söz cük ler: Bronşiyal karsinoid tümör; uzun dönem sonuç; parenkim koruyucu rezeksiyon. Background:This study aims to present surgical treatment, postoperative complications, and long-term outcomes in patients with a bronchial carcinoid tumor. Methods: Between January 2000 and December 2010, 57 patients (34 females, 23 males; mean age 43 years; range 13 to 83 years) underwent pulmonary resection for pre-and postoperatively pathologically confirmed bronchial carcinoid tumors. Type of surgery, histopathological types of carcinoid tumor, postoperative complications, and long-term results were evaluated. Results: Pathological examination revealed 44 (77%) typical and 13 (23%) atypical carcinoid tumors. Bronchial sleeve resection, pneumonectomy, lobectomy and sublobar resection were performed on 23 (40.3%), three (5.2%), 27 (47.3%) and four patients (7%), respectively. Eight patients (14%) had postoperative complications. There was no perioperative mortality. During the follow-up period, no mortality or local recurrence occurred. Conclusion: During long-term follow-up period, parenchyma-sparing resections (sleeve lobectomy and bronchial sleeve resection) can achieve good prognosis in patients with typical carcinoid tumor if tumor free surgical margins can be obtained.
European Journal of Cardio-thoracic Surgery, 2011
Objective: Pulmonary carcinoid tumors are rare low-grade malignant neoplasms and constitute 2-5% of all lung tumors. In this study, we aimed to determine the clinical presentations, types of surgery, long-term treatment outcomes and survival rates of patients diagnosed with carcinoid tumor treated surgically in our clinic. Methods: Patients operated in our clinic between 1992 and 2008 with confirmed or suspected diagnoses of carcinoid tumors were included in our study. Patients' hospital records were retrospectively analyzed. Results: A total of 104 patients (age 19-71 years, mean 44 AE 13 years, 2 SD) with pathologically confirmed carcinoid tumor were analyzed. A total of 84 patients (81%) were diagnosed as typical and the remaining 20 (19%) being atypical carcinoid tumor. As many as 24 patients (23%) were asymptomatic. The most frequent symptom was recurrent respiratory infection (35%). The most used surgical procedures were lobectomy (47%) and bilobectomy (16%). Mean postoperative follow-up period was 72 months (6-190 months). No surgery related mortality was noticed. As many as 15 (14%) patients died during the follow-up period. Overall 5-and 10-year survival rates were 89% and 72%, respectively. For typical carcinoid tumors, the 5-and 10-year survival rates were 92% and 83%, and for atypical carcinoids 73% and 46%, respectively ( p < 0.001). Conclusions: In our study, we noticed histological subtype, stage of the disease and the type of surgery performed to be prognostic factors of carcinoid tumors. Atypical carcinoid tumors tend to be more metastatic and had worse prognosis when compared with typical carcinoid tumors. We conclude that surgery is the best treatment of choice for carcinoid tumors, especially parenchyma-sparing procedures, because of their good mid-and long-term survival rates. #
Long-term results of surgical treatment of pulmonary carcinoids
Turkish Journal of Thoracic and Cardiovascular Surgery, 2015
ÖZ Amaç: Bu çalışmada akciğer karsinoidleri olan hastaların uzun süreli takiplerinde lenf nodu invazyonu ve hücre tipi dışında sağkalımı etkileyebilecek olası faktörler incelendi. Ça lış ma pla nı: Bu retrospektif çalışmaya Şubat 1993 -Kasım 2012 tarihleri arasında bronşiyal karsinoid tanısı ile ameliyat edilen 82 hasta (36 erkek, 46 kadın; ort. yaş 43.8 yıl; dağılım 16-19 yıl) dahil edildi. Sağkalımı etkileyebilecek faktörler yaş, cinsiyet, cerrahinin yeri, T statüsü, N statüsü, tam rezeksiyon, rezeksiyon genişliği, hücre tipi ve evre olarak belirlendi. Morbidite ve mortaliteler bu faktörlere göre kaydedildi. Bul gu lar: Ortalama takip süresi 84 ay idi. On yıllık sağkalım oranı %98.5 idi. Hastalardan 49'u T 1 , 29'u T 2 , dördü T 3 idi. Veriler T statüsünün sağkalımı etkilediğini gösterdi (p= 0.001). Yedinci TNM evreleme sistemine göre, hastaların 65'i evre 1, 14'ü evre 2, ikisi evre 3 idi. Bir hastada cerrahi sınırlar pozitif idi. Hastalık evresinin sağkalım üzerinde etkisi var idi (p= 0.023). Altmış sekiz hastada tipik, 14 hastada atipik karsinoid var idi. Tipik ve atipik karsinoidlerde sağkalımda farklılık yok idi (p= 0.62). Yetmiş hasta N 0 , 10 hasta N 1 ve iki hasta N 2 idi. Verilere göre, N durumu sağkalımı etkilemedi (p=0.72). So nuç: Çalışmamızda erken evrede tespit edilen tümörlere uygulanan cerrahide prognozun daha iyi olduğu bulundu. Anah tarsöz cük ler: Mortalite; pulmoner karsinoid tümör; sağkalım.
Long-term outcome after resection for bronchial carcinoid tumors
European Journal of Cardio-Thoracic Surgery, 2000
We sought to determine the long-term survival of patients treated for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. We conducted a retrospective, multi-institutional review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgical complications, tumor recurrence, and long-term survival were assessed. There were 50 men and 89 women with a mean age of 52.2+/-17.4 and 58.9+/-13.3 years, respectively (P=0.021). Men were more likely to be current or former smokers than were women. Operations included lobectomy or bilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronchial sleeve resection only in three patients; resection was performed thoracoscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid tumors were stage I in 100 and more advanced (stages II-IV) in nine, whereas atypical carcinoid tumors were stage I in 18 and more advanced in eight (P=0. 002). Median follow-up was 43 months (range 1-149) during which 21 (15%) patients died (four from recurrent cancer) and 19 patients (14%) were lost to follow-up. Recurrent cancer developed in 2/98 patients with typical and 5/25 patients with atypical subtypes (P<0. 001; log-rank test). The likelihood of recurrence was related to histological subtype (relative risk 7.9 for atypical carcinoid; 95% confidence interval 1.4-43.5). Five-year survival was 88% for stage I patients and was 70% for patients with more advanced stages. When stratified by stage, survival was related to age (relative risk=1.9 for a 10 year increase in age; 95% confidence interval 1.2-2.9) and possibly to the histological subtype, but not to patient gender, year of operation, or type of operation performed. Either major lung resection or wedge resection is appropriate treatment for patients with early stage typical bronchial carcinoid tumors. Survival is favorable for early stage tumors regardless of histological subtype. Local recurrence is more common among patients with atypical subtypes, suggesting that a formal resection may improve long-term outcome.
Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification
The Annals of Thoracic Surgery, 2003
Background. Pulmonary carcinoid tumors represent a group of malignant neoplasms comprised of neuroendocrine cells. In 1999, the World Health Organization (W.H.O.) proposed the definitive classification of neuroendocrine tumors based on the criteria from Travis and associates. The W.H.O. described two different groups of carcinoid tumors: typical carcinoids (TC) and atypical carcinoids (AC). Few reports have reviewed their data according to the current classification, and therefore, prognosis and standard therapy for TC and AC are still uncertain. Methods. From 1980 to 2001, 98 pulmonary resections have been performed for primary bronchial carcinoid tumors in our Thoracic Department of the University of Milan. We reviewed original histology using the current W.H.O. criteria and identified 88 patients with TC and 10 with AC. We reviewed the outcomes in each group. Results. The 5 year-overall survival rate was 91.9% for TC and 71% for AC. The 10-year overall survival rate was 89.7% for TC and 60% for AC. The 5-year TNM-related survival rates in the TC group were: IA-B, 100%; IIA-B, 75%; and IIIA, 50%. At 10 years, they were: IA-B, 100%; IIA-B, 75%; and IIIA, 0%. The 5-year survival rates in the AC group were: IA-B, 100%; IIA-B, 100%; and IIIA, 0%. At 10 years, they were: IA-B, 100%; IIA-B, 66%; and IIIA, 0%. Conclusions. Prognosis is favorable for both subtypes in the early stage. Advanced stages are related to better prognosis in TC. Recurrences rate is worse in the AC subtype. Our data suggest avoiding limited resections when feasible in AC. Parenchyma-sparing resections should be encouraged in TC. From 1980 to 2001, 98 patients underwent parenchyma lung resection for carcinoid tumors in our Thoracic Department of the University of Milan. There were 52 men and 46 women. The original histologic diagnosis has