El Jamal M, Nicholson A G, Goldstraw P
Department of Thoracic Surgery, Royal Brompton Hospital, London, UK.
Eur J Cardiothorac Surg. 2000 Sep;18(3):301-6. doi: 10.1016/s1010-7940(00)00519-4.
To assess the feasibility of a policy of conservative resection for carcinoid tumours, to validate this by a study of recurrence rates and survival, and to assess those factors that might frustrate such a policy.
Over 20 years, 95 patients with a final histological diagnosis of carcinoid tumour were assessed for surgery. During this time we had a policy of conservative resection for such tumours, with preservation of functional lung parenchyma wherever possible.
The mean age at presentation was 51 years (range 14-81). Symptoms were present in 62 patients (65.3%). Fifty-eight tumours (61.1%) were central in position. Surgical resection was performed in 92 patients. Three patients (3.3%) underwent pneumonectomy: in two because the situation was complicated by destruction or severe damage to the distal lung parenchyma, and in one the initial biopsy was interpreted as lung cancer. Less than 50% of patients were referred with the correct histological diagnosis. In 18% preoperative biopsies were interpreted as non-small cell lung cancer (NSCLC). At thoracotomy similar confusion remained with 26% of frozen section reports suggesting NSCLC. In those patients coming to thoracotomy, lymph node involvement was present in 15 patients (16.3%) (N1 in 13 patients, N2 in two patients) being found in 11 of 81 (13.6%) patients whose tumours showed typical histological features, and four of the 14 patients whose tumours (28.5%) displayed atypical features. During follow-up from 6 months to 12 years (mean 3.9 years) four of the 92 operated patients were found to have local recurrence and underwent further surgery and three others developed distant metastases (3.2%), two of whom have died.
Bronchial carcinoid is now considered to be a low-grade, but malignant tumour. Despite this we have found over the last 20 years that a policy of conservative resection is feasible and safe whenever the true histology is known and the distal lung parenchyma is functional. This is not affected by the presence of nodal involvement or atypical features and the long-term results of conservative resection are not affected by the presence of nodal disease. These factors should not influence the extent of surgical resection.
评估类癌肿瘤保守性切除策略的可行性，通过对复发率和生存率的研究来验证这一策略，并评估可能阻碍该策略实施的因素。
在20多年间，对95例最终经组织学诊断为类癌肿瘤的患者进行了手术评估。在此期间，我们对这类肿瘤采取保守性切除策略，尽可能保留有功能的肺实质。
患者就诊时的平均年龄为51岁（范围14 - 81岁）。62例患者（65.3%）有症状。58个肿瘤（61.1%）位于中央部位。92例患者接受了手术切除。3例患者（3.3%）接受了肺切除术：2例是因为病情因远端肺实质破坏或严重受损而复杂化，1例是因为最初的活检被误诊为肺癌。不到50%的患者被正确诊断为类癌肿瘤。18%的术前活检被误诊为非小细胞肺癌（NSCLC）。在开胸手术时，类似问题依然存在，26%的冰冻切片报告提示为NSCLC。在接受开胸手术的患者中，15例（16.3%）有淋巴结受累（13例为N1，2例为N2），在81例肿瘤具有典型组织学特征的患者中有11例（13.6%）发现淋巴结受累，在14例肿瘤具有非典型特征的患者中有4例（28.5%）发现淋巴结受累。在6个月至12年（平均3.9年）的随访期间，92例接受手术的患者中有4例出现局部复发并接受了进一步手术，另外3例发生远处转移（3.2%），其中2例死亡。
支气管类癌现在被认为是一种低级别但恶性的肿瘤。尽管如此，我们发现在过去20年里，只要明确了真实组织学情况且远端肺实质有功能，保守性切除策略就是可行且安全的。这不受淋巴结受累或非典型特征的影响，保守性切除的长期结果也不受淋巴结疾病的影响。这些因素不应影响手术切除范围。
