Davini F, Gonfiotti A, Comin C, Caldarella A, Mannini F, Janni A
Thoracic Surgery Service, Careggi Hospital, Florence, Italy2 Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
J Cardiovasc Surg (Torino). 2009 Dec;50(6):807-11. Epub 2008 Oct 24.
The aim of this study was to conduct a retrospective clinical and pathological analysis of the authors' 20-year experience on treatment of typical and atypical carcinoid tumours.
A retrospective clinical and pathological analysis was conducted on 89 patients treated for bronchial carcinoid neoplasms at the Division of Thoracic Surgery, Hospital of Florence (Italy) between January 1986 and January 2006. They were 47 male (52.8%) and 42 female patients, age ranging from 22 to 77 years (average: 55.5 years). Diagnosis was made with radiological methods such as plain chest roentgenography, computed tomography (CT), and bronchoscopy. On the basis of bronchoscopic findings 63 carcinoids (70.8%) were centrally located and 26 (29.2%) were classified as peripheral. In 38 cases of central lesion the diagnosis was obtained by endobronchial biopsy. A correct pathological diagnosis was obtained before surgery in 58 patients; in the others resected cases the correct diagnosis was determined by intraoperative histology during surgery. All operation were performed through a thoracotomy, with sparing muscle in last ten years. Surgical procedures utilized were lobectomy, pneumonectomy, segmentectomy, wedge resections, sleeve resections and bronchoplastic procedures. A radical mediastinal lymphadenectomy was performed in every operation.
There were 63 (70.8%) typical carcinoid (TC) and 26 (29,2%) atypical carcinoid (AC). No operative or postoperative mortality was seen. Ten patients (11.7%) experienced complications: 4 prolonged air leaks, 2 bleeding requiring re-operation, 1 chylothorax, 1 pulmonary embolism, 2 late cicatricial bronchial stenosis after sleeve lobectomy treated successfully by laser therapy. Four patients (4.5%) were treated with endoscopy plus surgery. In all that patients a Laser Nd-YAG coagulation and excision of the lesion was performed. Four patients (4.5%) were treated only with endoscopy, overall because of bad general condition. On the basis of the hystopatological documentation of all patients operated before 1999 (60 patients) the authors observed that in 4 cases (6.6%) the diagnosis has changed from AC to TC while only 1 case (1.6%) of AC was classified as TC with new criterias. During median 122-month follow-up 7 relapses (8.2%) were diagnosed in operated patients; recurrent cancer developed preferentially in AC (N=4, 16.6%) than TC (N=3, 4.9%). The overall survival at 10 and 15 years was 92% and 82% respectively.
Anatomical resection, including formal lobectomy (or pneumonectomy when indicated) and radical mediastinal lymphadenectomy, should be performed in carcinoid tumours.
本研究旨在对作者20年来治疗典型和非典型类癌肿瘤的经验进行回顾性临床和病理分析。
对1986年1月至2006年1月期间在意大利佛罗伦萨医院胸外科接受支气管类癌肿瘤治疗的89例患者进行回顾性临床和病理分析。其中男性47例（52.8%），女性42例，年龄22至77岁（平均55.5岁）。通过胸部X线平片、计算机断层扫描（CT）和支气管镜检查等放射学方法进行诊断。根据支气管镜检查结果，63例类癌（70.8%）位于中央，26例（29.2%）为周围型。在38例中央病变中，通过支气管内活检获得诊断。58例患者在手术前获得了正确的病理诊断；在其他切除病例中，通过手术中的术中组织学确定了正确诊断。所有手术均通过开胸进行，在过去十年中采用了保留肌肉的方法。采用的手术方式包括肺叶切除术、全肺切除术、肺段切除术、楔形切除术、袖状切除术和支气管成形术。每次手术均进行根治性纵隔淋巴结清扫术。
有63例（70.8%）典型类癌（TC）和26例（29.2%）非典型类癌（AC）。未观察到手术或术后死亡。10例患者（11.7%）出现并发症：4例持续性漏气，2例出血需再次手术，1例乳糜胸，1例肺栓塞，2例袖状肺叶切除术后晚期瘢痕性支气管狭窄经激光治疗成功。4例患者（4.5%）接受了内镜检查加手术治疗。在所有这些患者中，均进行了激光钕钇铝石榴石凝固和病变切除。4例患者（4.5%）仅接受了内镜检查，总体原因是全身状况较差。根据1999年前手术的所有患者（60例）的组织病理学记录，作者观察到4例（6.6%）的诊断从AC变为TC，而只有1例（1.6%）的AC根据新标准被归类为TC。在中位122个月的随访中，手术患者中诊断出7例复发（8.2%）；复发癌在AC（n = 4，16.6%）中比TC（n = 3，4.9%）中更易发生。10年和15年的总生存率分别为9
