Two-Stage Surgery Without Parenchyma Resection for Endobronchial Carcinoid Tumor.

Abstract

The aim of the study was to evaluate the efficacy of a combined approach of endoscopic resection followed by pure bronchoplasty without any pulmonary resection in patients with endobronchial carcinoids. We applied a two-stage technique, endoscopic resection first followed by pure bronchoplasty, to 25 patients (10 men, 15 women) with endobronchial carcinoid tumors. The median age was 32.4 years (range, 19 to 64). The indications for this technique were pure endobronchial carcinoid without lymph node involvement. Tumor was located on the right side in 18 patients (72%), and on the left in 7 patients (28%). Flexible bronchoscopy was carried out in all patients as the first-stage procedure for debulking and searching for a true pedicle of the tumor. Different types of pure bronchoplasty were performed as the second-stage surgery with systematic mediastinal lymph node dissection. The resection was complete (R0) in all cases. Tumors were pathologically staged as pT1aN0 in 18 patients, pT2N0 in 5, and pT3N0 in 2 patients; 23 tumors were typical and only two were atypical carcinoids. Morbidity was 28.0% (only minor complications), with no mortality. Overall 5-year and 10-year survival was 100.0% and 91.8%, respectively. No recurrence of the primary tumor was observed in any case. Two-stage surgery consisting of endoscopic resection and pure bronchoplasty without lung parenchyma resection is an effective technique for the treatment of endobronchial carcinoid, with an excellent oncologic outcome.