Long-term outcome after resection for bronchial carcinoid tumors

Objectives: We sought to determine the long-term survival of patients treat ed for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. Methods: We conducted a retrospective, multi-instituti onal review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgica l complications, tumor recurrence, and longterm survival were assessed. Res ults: There were 50 men and 89 women with a mean age of 52.2 +/- 17.3 and 5 8.9 +/- 13.3 years, respectively (P = 0.021). Men were more likely to be cu rrent or former smokers than were women. Operations included lobectomy or b ilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronch ial sleeve resection only in three patients; resection was performed thorac oscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid rumors were st age I in 100 and more advanced (stages II-IV) in nine, whereas atypical car cinoid tumors were stage I in 18 and more advanced in eight (P = 0.002). Me dian follow-up was 43 months (range 1-149) during which 21 (15%) patients d ied (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 patie nts with atypical subtypes (P < 0.001; log-rank test). The likelihood of re currence was related to histological subtype (relative risk 7.9 for atypica l 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. Wh en stratified by stage, survival was related to age (relative risk = 1.9 fo r 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. Conclusions: Either major lung resection or wedge resection is appropriate treatment for patients with early stage typ ical bronchial carcinoid tumors. Survival is favorable for early stage tumo rs regardless of histological subtype. Local recurrence is more common amon g patients with atypical subtypes, suggesting that a formal resection may i mprove long-term outcome. (C) 2000 Elsevier Science B.V. All rights reserve d.