Surgical Management and Long-Term Outcome of Bronchial Carcinoids

Kang, Jeong Han; Chung, Kyung Young; Kim, Kil Dong; Choi, Sung Sil; Shin, Dong Hwan; Kim, Se Hoon

Abstract

BACKGROUND: Bronchial carcinoids account for approximately 2% of all pulmonary tumor and consist of typical carcinoids and atypical carcinoids. An atypical carcinoid is considered to be an intermediate form of tumor between a low-grade malignant typical carcinoid and a high-grade malignant small cell lung carcinoma. There is still controversy with regard to the extent of resection and the value of systemic adjuvant therapy in atypical carcinoids. We performed a retrospective review of our experiences at Severance Hospital. MATERIAL AND METHOD: Between 1990 and 2000, 15 patients with bronchial carcinoids were operated, and 5 of these had atypical carcinoids. Histologic diagnosis was established on the criteria of WHO/IASLC(1999). RESULT: There were 3 pneumonectomies, 11 lobectomies, and 1 segmentectomy. In typical carcinoids, one patient had regional lymph node metastasis, and 3 patients in atypical carcinoids had mediastinal lymph node metastases. Distant metastases developed in one patient of typical carcinoid, but developed in 4 patients of atypical carcinoids(p=0.0017). The 5-year survival rate in patients with atypical carcinoids was 20%, versus the 100% 5-year survival rate observed in patients with typical carcinoids(p=0.0039).
CONCLUSION
In atypical carcinoids, because of many lymph node metastases on diagnosis and a low long-term survival rate, lobectomy constitutes a mininal procedure. Adjuvant systemic therapy is recommended for patients with lymph node and distant metastasis.