Endobronchial resection as a bridge to curative resection in patient with poor preoperative lung function secondary to an airway blocking endobronchial carcinoid tumour (original) (raw)

Endobronchial Treatments of Carcinoid Tumors of the Lung

2015

Background Bronchial carcinoid tumors are known as low-grade malignancies. Surgery has been proposed as the best treatment of choice for lung carcinoids. However, less invasive treatment approaches may be considered due to low-grade malignancy potential of such tumors. The aim of this study was to review the results of endobronchial treatments of carcinoid tumors of the lung and to compare with the outcome after surgery. Methods Initial complete tumor eradication with an endobronchial treatment was attempted for 29 patients. Diode laser or argon plasma coagulation was used during these treatments. Cryotherapy or laser treatments were applied consecutively in patients for whom there was good bronchoscopic visualization of the distal and basal tumor margins and no evidence of bronchial wall involvement. Surgery was performed in cases of atypical carcinoid and in cases of nonvisualization of the basal and distal part of the tumor. Results Overall, 29 patients have been included (median age 58 years; range, 23-77 years). Median follow-up has been 49 months (range, 22-94 months). A total of 24 patients (69%) had typical carcinoid tumor, 5 patients (31%) had atypical carcinoid tumor. Initial endobronchial treatment provided complete tumor eradication in 21 of 29 patients (72%). Of the eight other patients (28%), two were atypical carcinoids, and underwent surgical treatment. There was no tumor-related death and no recurrence during the follow-up in both groups. There was no difference for survival or recurrence between the surgical and the endobronchial treatment group of patients (p > 0.05). Conclusion Endobronchial treatment may be considered as safe, effective treatment for typical carcinoid tumors in the central airways. Addition of initial endobronchial treatment had no negative effect on the surgical outcome.

Endobronchial Treatment of Carcinoid Tumors of the Lung

The Thoracic and cardiovascular surgeon, 2015

Bronchoscopic management of endobronchial carcinoid presenting as asthma Mimic

Respiratory Medicine Case Reports, 2020

We report a 25-year-old woman with persistent dyspnea and wheezes that had been unsuccessfully treated with inhaled beta 2-agonists and steroids for about one year. Spirometry demonstrated a restrictive pattern. Chest CT demonstrated polypoidal lesion in left main bronchus. The lesion was excised via rigid bronchoscopy. Pathology showed a picture of typical bronchial carcinoid. In this patient, due to the lack of awareness, diagnosis of carcinoid was delayed for one year.

Endoscopic Treatment of Bronchial Carcinoids in Comparison to Surgical Resection

Journal of Bronchology & Interventional Pulmonology, 2012

Background: Surgery is the gold standard of lung carcinoid treatment. However, bronchoscopic treatment may provide a complete cure in selected patients. The aim of the study was to review the results of laser treatment of bronchial carcinoids and to compare the outcome after laser resection against the outcome after surgical resection. Methods: Seventy-three patients, 29 men and 44 women, median age 53 years (range, 23 to 78 y), with bronchial carcinoids were treated by surgical resection (n = 48) or endobronchial ablation (n = 25). Bronchoscopic treatment was also performed in 5 of 48 surgical patients as a part of the surgical treatment strategy. Results: Among 25 patients treated endoscopically, 16 were successfully treated with laser, whereas 9 were operated subsequently. One major complication was registered, as an inadvertent ventilation caused a nonfatal fire of the bronchoscope during Nd:YAG laser procedure. Forty-eight patients underwent surgical resection. Most of the patients underwent lobectomy and bilobectomy (30 and 5 patients, respectively). Four of the patients were dead by the end of the study, 1 was treated with laser, and 3 treated with surgical resection. The overall survival was 94.5% in the surgical group and 94.4% in the group treated with endoscopic ablation (P = 0.9). None of the 69 survivors had any sign of recurrence on computed tomographic scans and bronchoscopy by the end of the study. Conclusions: This is a retrospective study and no randomization has been performed. However, the results add evidence to the view that transbronchial laser treatment may be offered as a safe, stand-alone procedure in the treatment of typical carcinoid tumor in the central airways.

Long-term follow-up after first-line bronchoscopic therapy in patients with bronchial carcinoids

Thorax, 2015

Background Carcinoid of the lung is considered to be a low-grade malignancy. A subgroup presents as an endobronchial tumour. Surgical resection is considered the standard approach because of its metastatic potential and the possibility of an iceberg phenomenon for the endobronchial subgroup. Advances in noninvasive and minimally invasive technologies seem to justify a more lung parenchyma-sparing approach. Methods In patients presenting with bronchial carcinoids, initial bronchoscopic treatment (IBT) is first attempted for complete tumour eradication and sufficient tissue sampling for the proper differentiation of typical (TC) versus atypical (AC) histological type. Furthermore in cases with postobstruction problems the desobstruction is aimed at improving the patient's condition and by that alleviate surgery if that is needed. High resolution CT is performed 6 weeks post IBT to determine local tumour growth. Surgical resection follows in case of extraluminal disease, residual carcinoid inaccessible for IBT, or late recurrences not salvaged by repeat IBT. Results Minimum follow-up was 5 years from start of treatment for 112 patients (65 women, 47 men), with a median age of 47 years (range 16-77 years). Eightythree patients (74%) had TC, and 29 (26%) AC. IBT only was ultimately curative in 42% of the cases (47/112): 42 TC, 5 AC. Disease-specific mortality including surgical mortality has been 2.6% (3/112) in patients with extraluminal carcinoids (3 AC). Conclusions IBT, if with unsuccessful rescue surgery, is justifiable with excellent long-term outcome. IBT made surgery unnecessary in 42% of the cases. Iceberg phenomenon and metastatic potential in this group of patients with bronchial carcinoids are clinically insignificant.

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.

Bronchoscopic treatment of intraluminal typical carcinoid: A pilot study

The Journal of Thoracic and Cardiovascular Surgery, 1998

The curative potential of various bronchoscopic treatments such as Nd:YAG laser, photodynamic therapy, and brachytherapy for the treatment of intraluminal tumor has been reported previously. Bronchoscopic treatment can be used to treat small intraluminal tumor with curative intent, such as in patients with roentgenologically occult squamous cell cancer. In a retrospective study, we showed that bronchoscopic treatment provided excellent local control with surgical proof of cure in 6 of 11 patients with intraluminal typical bronchial carcinoid. Methods: In a prospective study, 19 patients (8 women and 11 men) with resectable intraluminai typical bronchial carcinoid have undergone bronchoscopic treatment under general anesthesia. Median age was 44 years (range, 20-74 years). If tumor persisted after 2 bronchoscopic treatment sessions, surgery was performed within 4 months after the treatment. Results: Bronchoscopic treatment was able to completely eradicate tumor in 14 of the 19 patients (complete response rate 73%, 95% Ch 49%-91%). Median follow-up of these patients is 29 months (range, 8-62 months). One patient had severe cicatricial stenosis after bronchoscopic treatment, and sleeve lobectomy was necessary. No residual carcinoid was found in the resected specimen. In the remaining 5 patients, bronchoscopic treatment did not result in a complete response and radical surgical resection was performed afterward with confirmation of residual carcinoid in the resected specimen. Median follow-up of the surgical group is 34 months (range, 12-62 months). Conclusions: Current data suggest that bronchoscopic treatment may be an effective alternative to surgical resection in a subgroup of patients with resectable intraluminal typical bronchial carcinoid. It alleviated the necessity of surgical resection in 68% (95% CI: 43%-87%) of the patients.

Endobronchial carcinoid managed by surgery and radiation therapy

European Journal of Radiology Extra, 2006

Carcinoid tumor is a rare entity accounting for less than 2% of bronchial neoplasms. The clinical presentation is highly variable and rarely, it may present as a solitary pulmonary nodule. Management is by surgical removal. Role of radiation is unclear.

Endobronchial resection as a bridge to curative resection in patient with poor preoperative lung function secondary to an airway blocking endobronchial carcinoid tumour (original) (raw)

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