Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

Abstract

A B S T R A C TThe treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.

Neuroendocrine syndrome in bronchial carcinoid tumors

“…In two cases PET-CT was used for patient that had atypical carcinoids with neuroendocrine syndromes. Recent studies have demonstrated that the factors which lead to a negative outcome are lymph node metastasis, the histological differentiation degree, location of the tumor (central or peripheral) as well as tumor size (32).…”

Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature

“…Typical carcinoids are less aggressive with 5-year survival rates of 87-100% and 10-year survival rates of 82-87%. Atypical carcinoids have a more malignant behaviour with significantly lower 5-and 10-year survival rates of 50-95% and 38-75%, respectively [9,10]. A recent review showed that tumour size, histology of atypical carcinoids, and lymph node metastasis have negative impacts on survival from pulmonary carcinoids [10].…”

“…Atypical carcinoids have a more malignant behaviour with significantly lower 5-and 10-year survival rates of 50-95% and 38-75%, respectively [9,10]. A recent review showed that tumour size, histology of atypical carcinoids, and lymph node metastasis have negative impacts on survival from pulmonary carcinoids [10]. Regarding tumour diameter, YANG et al [11] showed that in patients with carcinoid tumour sizes ⩾3 cm, prognosis was significantly worse than for those with tumour sizes <3 cm.…”

“…Surgical resection, using either anatomical resection (lobectomy, bilobectomy and pneumonectomy) or a parenchyma-sparing technique (segmentectomy, sleeve lobectomy, bronchial sleeve, wedge or enucleation of the tumour), remains the gold standard treatment for carcinoids. Studies looking at anatomical resections show higher recurrence rates of malignancy compared with parenchyma-sparing resection studies [10]. BOLUKBAS and SCHIRREN [41] suggested that, for typical carcinoids, parenchyma-sparing resections should be favoured over anatomical resections.…”

Endobronchial Treatment of Bronchial Carcinoid in the Elderly

“…With this technique, several studies have shown excellent long-term outcome [6][7][8][9][10][11]. A recent systematic review by Reuling et al evaluated all studies utilizing either surgical resection and/or EBT [12]. The authors concluded that centrally located, small intraluminal pulmonary carcinoids, without signs of metastasis, can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection.…”