Clinical-radiological presentation and outcome of surgically treated pulmonary carcinoid tumours: a long-term single institution experience

Abstract

Purpose: To determine the presenting features and the outcome of surgically treated pulmonary carcinoid tumours.

Methods: Retrospective analysis of all consecutive cases with preoperatively suspected or proven pulmonary carcinoid, treated between 1964 and 1994, in order to have full 5-year survival data.

Results: Seventy-three patients were retrieved, six had a postoperative histology other than carcinoid. The mean age of the 67 eligible cases was 44 years (range 17-74). There were 59 typical and eight atypical carcinoids. The most frequent presenting symptom was infection, followed by haemoptysis. Sixteen patients were asymptomatic, 15 of these had an abnormal chest X-ray, showing a solitary nodule in 13. Bronchoscopy was abnormal in almost all symptomatic patients. Bronchial biopsy results suggested a malignancy other than carcinoid in seven of eight patients whose postoperative histology was found to be atypical carcinoid. There were 40 lobectomies, 14 bi-lobectomies, nine pneumonectomies, and four limited resections. Ten patients had lymph node involvement (seven typical and three atypical). There was no correlation between the diameter of the primary tumour and the presence of nodal involvement. In particular, three of eight peripheral lesions <30 mm were found to have metastatic lymph nodes. The 5-year survival was 92% (95% in N0 versus 56% in N1-2; 92% in typical versus 67% in atypical). The 10-year survival was 84%.

Conclusion: The specific diagnosis of atypical carcinoid cannot be reliably made on bronchial biopsies. No relationship was found between tumour size and the presence of lymph node metastases, suggesting that radical excision with detailed lymph node sampling is as important in carcinoids as in other lung cancers. Long-term survival was excellent, nodal status and pathology (typical/atypical) were independent prognostic factors.