Survival and bronchial carcinoid tumors: Development of surgical techniques in a 30-year experience of 82 patients in China

Background: We aimed to identify the factors determining long-term survival after surgical management for bronchial typical carcinoid (TC) and atypical carcinoids (AC) and to compare the clinical outcome of the different surgical strategies used in the two periods of 1980-1994 and 1995-2005.

Methods: Records of 82 patients with an initial pathological diagnosis of bronchial carcinoid tumor who underwent surgical management from January 1980 to December 2009 were reviewed. Tumors were classified as TC or AC using the 2004 World Health Organization criteria.

Results: There were 60 TC and 22 AC. Surgical procedures included lobectomies, sleeve or bronchoplastic resections, pneumonectomies, wedge resections, and segmental resections. Significantly fewer pneumonectomies and more sleeve and bronchoplastic resections were performed after 1994. The prognosis was more favorable for TC than AC. Comparing lymph node status N0 with N1 + N2, 5- and 10-year survival was 92% and 85% vs. 61% and 41%. No patient with lymph node involvement survived more than 15 years.

Conclusions: Tumor subtype and lymph node status have the greatest impact on long-term survival following surgery. AC and/or regional lymph node metastases have the worst prognosis. Formal anatomic and tissue-saving lung resection plus systematic radical mediastinal lymphadenectomy for TC and AC should be standard.