Sublobar resection in the treatment of peripheral typical carcinoid tumors of the lung.
The Annals of thoracic surgery
BACKGROUND: The role of sublobar resection in the treatment of pulmonary typical carcinoids is controversial. This study aims to compare long-term outcomes between sublobar and lobar resections in patients with peripheral typical carcinoid.
METHODS: We retrospectively compared consecutive patients who underwent curative sublobar resection to lobectomy for cT1-3N0M0 peripheral pulmonary typical carcinoid in eight centers between 2000-2015. Primary outcomes were rates and patterns of recurrence and overall survival. Cox regression modeling was performed to identify factors influencing overall survival and recurrence. Propensity score analysis was done and overall survival was compared between the two groups.
RESULTS: A total of 177 patients were analyzed including 74 sublobar resections and 103 lobectomies with a total of 857 person-years of follow-up. R1 resection rate was 7% and 1% after sublobar resection and lobectomy, respectively (p=0.08). One of 5 patients with sublobar R1 resection developed recurrence. Recurrence rate was 0.02 (95%CI:0.009-0.044) per person year of follow-up after sublobar resection and 0.008 (95%CI:0.003-0.02) after lobectomy (p=0.15). Five-year survival rates were 91.7% (95%CI:78.5-96.9%) and 97.4% (95%CI:90.1-99.4%) after sublobar and lobar resection respectively (p=0.08). Extent of resection was not a predictor of recurrence or survival. Propensity score analysis confirmed a similar survival and freedom from recurrence between the two groups.
CONCLUSIONS: Sublobar resection of peripheral cT1-3N0M0 pulmonary typical carcinoid was not associated with worse short or long-term outcomes compared to lobectomy. In select patients, sublobar resection may be considered for treatment of peripheral typical carcinoids if an R0 resection is obtained.
Cattoni, Maria; Vallières, Eric; Brown, Lisa M; Sarkeshik, Amir A; Margaritora, Stefano; Siciliani, Alessandra; Filosso, Pier Luigi; Guerrera, Francesco; Imperatori, Andrea; Rotolo, Nicola; Farjah, Farhood; Wandell, Grace; Costas, Kimberly E; Mann, Catherine; Hubka, Michal; Kaplan, Stephen; Farivar, Alexander S; Aye, Ralph W; and Louie, Brian E, "Sublobar resection in the treatment of peripheral typical carcinoid tumors of the lung." (2019). Articles, Abstracts, and Reports. 1661.