Advances in Endoscopic Management of Endobronchial Carcinoid

Abstract

Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients.

Materials and methods: The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant'Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29-75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment.

Results: Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (p-value > 0.05-it means statistically insignificant).

Conclusions: Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery.

Keywords: argon plasma coagulation; bronchial carcinoid; endobronchial treatment; rigid broncoscopy.

Figure 1

Well-vascularised polypoid lesion of 9 mm in diameter, rounded, pink in colour, with a hard elastic consistency (A,B) detected at the beginning of the right main bronchus (C).

Figure 2

(A,B) Clearance of tumor was mostly performed by mechanical removal and through the working channel of the rigid bronchoscope of size 8.5 mm.

Figure 3

Argon plasma coagulation and diode laser (980 nm wavelength from 4 to 25 W in pulsed mode) were used to perform implant base coagulation and hemostasis during endobronchial treatment (A–C). Total lesion removal was performed using forceps and coagulation stages with automatic peak voltage control (D,E). All bronchial branches were explored after debulking (F).

Figure 4

Kaplan–Meier estimator: there were no significant differences between patients who received endobronchial treatment (Group 2) and patients who received surgical treatment (Group 1) in terms of survival in the present study.