The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 281-291, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Bronchoplastic procedures in the treatment of carcinoid tumors of the tracheobronchial tree
N Okike, PE Bernatz, WS Payne, LB Woolner and PF Leonard
Sixteen patients, aged 10 to 70 years, had carcinoid tumors of the lower
respiratory tract treated by various resective tracheobronchoplastic
procedures. These represent 8.8 percent of 181 patients with carcinoid
lesions treated during a recent 20 year period. All 16 patients had
respiratory symptoms, and one patient also had the carcinoid syndrome.
Roentgenographic changes ranged from a mass or atelectasis (or both)
through unilateral lung hyperinflation to clear lungs with subtle filling
defects in major airways. All tumors were visualized endoscopically, and 13
patients had biopsies. Histopathologically, all tumors were "typical"
carcinoids . Before operation, the patients had minimal or no respiratory
insufficiency, although flow-volume and ventilation-perfusion abnormalities
were noted when major airways were affected. Surgical management at
thoracotomy was as follows: (1) simple wedge tracheobronchotomy without
lung resection (five patients); (2) bronchial sleeve resection without lung
resection (three patients); and (3) bronchial sleeve with upper lobe
resection (eight patients). These 16 operations were performed with eight
technical anatomic variations. No early or late deaths occurred. One
patient had early transient atelectasis, and three patients required late
endoscopic removal of suture granulation tissue. All patients were alive
without recurrence of tumor or carcinoid syndrome or other respiratory
complications 6 months to 19 years postoperatively. Pulmonary resection
should be avoided unless there is histologic evidence of tumor extension
into lung parenchyma or irreversible pulmonary suppuration distal to the
obstructive tumor.
