Surgical Treatment of Pulmonary Carcinoids - Ten-Year Results

Introduction: Carcinoids are malignant neuroendocrine tumours occurring in the bronchopulmonary location in about 25%, and accounting for approximately 2% of all pulmonary tumours. Material and Methods: Our retrospective analysis included 27 patients, 14 men and 13 women, mean age 58.4 years, treated from 2000 to 2009 for carcinoids in bronchopulmonary locations. The tumour manifested clinically in 52% of the cases, the most common symptom being cough; one tumour manifested as carcinoid syndrome. All patients underwent fibrobronchoscopy that was positive in 20 cases (74.1%). Pre-surgery histological diagnoses were made in 13 patients (48.1%). Chest CT scans were carried out in 26 patients, and the investigation failed to detect the expected pathological process in 2 of the patients. Octreoscans were carried out in 12 patients, and were successful in identifying a primary neuroendocrine tumour in 75%. Results: All patients in the sample underwent radical surgical therapy; the most common surgical procedure was lobectomy (70.4%). Perioperative morbidity and mortality were zero. Typical carcinoids were found in 20 cases while 7 cases were atypical carcinoids, 20 tumours were located centrally. 74% of the tumours were consistent with stage IA disease. Mean follow-up period was 47 (range: 6-134) months. Local recurrences were observed in 2 patients (7.4%), but the tumour disseminated in 4 patients (14.8%). Two patients (7.4%) died during the follow-up period. Overall five-year survival in the sample was 92.3%, 90.9% in the typical carcinoid group and 100% for atypical carcinoids. We found a statistically significant association between disease-free interval and histological type of the tumour; the risk of progression was 8 times higher in patients with atypical carcinoids compared to patients with typical carcinoids (Log-Rank-Test: p-value = 0.0049). Conclusion: Radical surgical treatment of bronchopulmonary carcinoids is the optimum therapeutic approach that results in the best results both regarding perioperative morbidity and mortality and regarding long-term survival of the patients.