Bishnoi Sukhram, Asaf Belal Bin, Puri Harsh Vardhan, Pulle Mohan Venkatesh, Gopinath Srinivas Kodaganur, Sharma Shikha, Patel Mitul Vinodbhai, Kumar Arvind
Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India.
Department of Anaesthesia, sir Ganga Ram Hospital, New Delhi, 110060 India.
Indian J Surg Oncol. 2021 Mar;12(1):190-198. doi: 10.1007/s13193-020-01248-7. Epub 2020 Oct 21.
Bronchial carcinoids are slow-growing tumours of the neuroendocrine family. Most of them have a benign course with excellent outcome after complete resection. Due to their location in the primary bronchi, adequate resection with lung preservation requires considerable technical expertise. In this paper we present our surgical experience with endobronchial carcinoids and analyse the factors that predict possibility of lung preservation surgery. Retrospective analysis of a prospectively maintained database of patients operated for endobronchial carcinoids for the period March 2012 to September 2019 was carried out. Demographic factors and peri-operative variables were recorded and analysed. Factors that influence surgical outcome and possibility of lung preservation surgery were analysed. A total of 137 patients underwent surgery for resection of carcinoid tumours, out of which 100 had endobronchial carcinoids whereas 37 had peripheral carcinoids. The surgical procedure in 100 patients with endobronchial carcinoids included 14 left main bronchus sleeve resections, 13 pneumonectomies (7 right sided and 6 left sided), 10 right lower and middle bi-lobectomies, 10 lobectomies (4 left upper, 2 left lower and 4 right upper), and 53 sleeve lobectomies (18 left upper lobe sleeves, 8 left lower lobe sleeves, 20 right upper lobe sleeves, 5 right middle lobe sleeves and 2 right lower lobe sleeve lobectomies). There was no operative mortality. Median tumour size was 3.9 cm (range 5-130 mm). On univariate analysis, longer duration of symptoms was associated with poor surgical outcomes. On multivariate analysis, tumour in the main bronchus, duration of disease < 3 months ( = 0.006), left-sided disease ( = 0.03), and presence of healthy distal lung parenchyma ( < 0.001) were associated with successful lung preservation. Majority of endobronchial carcinoid tumours can be managed with lung-sparing procedures with minimal morbidity and mortality and excellent immediate and short-term outcomes. Early referral and experience of team performing these complex procedures are the key to success.
支气管类癌是神经内分泌家族中生长缓慢的肿瘤。它们大多病程良性，完整切除后预后良好。由于其位于主支气管，要在保留肺组织的情况下进行充分切除需要相当的技术专长。在本文中，我们介绍了我们治疗支气管内类癌的手术经验，并分析了预测肺保留手术可能性的因素。对2012年3月至2019年9月期间接受支气管内类癌手术患者的前瞻性维护数据库进行回顾性分析。记录并分析人口统计学因素和围手术期变量。分析影响手术结果和肺保留手术可能性的因素。共有137例患者接受了类癌肿瘤切除手术，其中100例为支气管内类癌，37例为周围型类癌。100例支气管内类癌患者的手术方式包括14例左主支气管袖状切除术、13例全肺切除术（7例右侧和6例左侧）、10例右下和中叶双叶切除术、10例肺叶切除术（4例左上叶、2例左下叶和4例右上叶）以及53例袖状肺叶切除术（18例左上叶袖状切除术、8例左下叶袖状切除术、20例右上叶袖状切除术、5例右中叶袖状切除术和2例右下叶袖状肺叶切除术）。无手术死亡病例。肿瘤中位大小为3.9厘米（范围5 - 130毫米）。单因素分析显示，症状持续时间较长与手术结果不佳相关。多因素分析显示，主支气管内肿瘤、疾病持续时间<3个月（P = 0.006）、左侧病变（P = 0.03）以及存在健康的远端肺实质（P < 0.001）与成功的肺保留相关。大多数支气管内类癌肿瘤可以通过保留肺组织的手术进行治疗，发病率和死亡率极低，近期和短期效果良好。早期转诊以及实施这些复杂手术团队的经验是成功的关键。
