Radicality and prognosis of surgical treatment of thoracal carcinoid tumors: a review of 152 operated cases

Background: Experience of thoracal (bronchial and thymic) carcinoid tumors is discussed to add some remarkable diagnostic and therapeutic details for their treatment, based on a retrospective clinico-pathological analysis of 152 consecutive patients operated on at the Thoracic Surgery unit in Budape st between 1974 and 1988. Methods: Prior to surgery 70 patients were sympto m free, obstructive symptoms dominated in 65 patients, and hemoptysis occur red in 23 cases. In 68 patients a peripheral coin lesion was Visible in rad iographs and in 81 cases the tumor could be seen by bronchoscopy. in 3 pati ents the neoplasm appeared as mediastinal thymic-carcinoid. Pathological co nfirmation was based on routine light-microscopic sections, Grimelius techn ique, and immunohistochemical stainings for NSE and chromogranin. Bronchopl astic procedures were performed in 28 patients and limited (wedge or segmen tal) resection in 21 cases. Results: Atypical carcinoids were diagnosed in 18 cases. microscopic Vascular invasion could be seen in 70 tumors (46%), a nd 12 patients had a single hilar lymph-node metastasis. Immunostaining for NSE was evident in all carcinoids and 82% of the tumors presented positive reaction for chromogranin staining. Hospital mortality was 1.3%. The 5-yea r-survival rate amounted to 93% and the 10-year-survival rate to 83% (126/1 52). The early postoperative deaths were among 49 patients operated on by p arenchyma-sparing methods; the rest of these 49 are alive and free of sympt oms. Local recurrence occurred after a lobectomy and following removal of a mediastinal carcinoid. The tumors of 23 of the 26 dead patients showed Vas cular invasion, but 19 neoplasms among them had neither atypia nor regional lymph-node involvement. In the group of patients having tumors with signs of microscopic vascular invasion the 10-year-survival rate was 67%, while i n the others it amounted to 96%. Conclusions: Bronchial carcinoids require anatomic resection with lymph-node dissection. On the other hand, however, parenchyma-sparing methods have to be encouraged because of excellent late results. In our experience, immunohistochemistry for chromogranin can give some help in separation on the neuroendocrine tumor scale, and the presence of microscopic Vascular invasivity is the main prognostic factor.