Sleeve resection with or without parenchymal resection for proximal bronchial carcinoids: a retrospective analysis of recurrence and lymph node involvement.

Abstract

Objectives: Risk factors of recurrence in sleeve resection for endobronchial carcinoid tumors are well known. However, the impact of parenchymal sparing has not been studied. This study aims to determine whether associated parenchymal removal improves the oncologic outcomes.

Methods: Between 2002 and 2022, 95 patients underwent a sleeve resection for carcinoid tumors in two centers, 29 a bronchial sleeve resection (BSR) without parenchymal resection and 66 a parenchymal sleeve resection (PSR). Similar lymph node dissection was performed in both groups.

Results: The BSR group had more proximal tumors (p < 0.001) and higher NYHA class function (p < 0.001). The PSR group had more distal (p < 0.001) and larger tumors (p = 0.04). Preoperative bronchoscopic resection did not reduce "complex" sleeve resections, postoperative complications, or tumour recurrence rates. Ninety-day mortality was 0%. Postoperative complications, occurred in 18 patients (18.9%), with three bronchial fistulae (3.2%) and no anastomotic stenoses. All BSR patients were N0, while the PSR group had higher lymph node involvement (22.7% vs 0%; p = 0.004). Mean overall and recurrence-free survival were 104.1 and 100.9 months, respectively. Ten recurrences occurred, nine in the PSR group (p = 0.27). Associated parenchymal removal did not reduce risk of recurrence (p = 0.10). Atypical carcinoids and Ki-67 ≥ 5% were linked to lower recurrence-free survival in univariable analysis. Lymph node involvement was an independent risk factor for recurrence (p = 0.002) in multivariable analysis.

Conclusions: Absence of parenchymal resection did not affect oncologic outcomes, with minimal morbidity. Lymph node involvement was an independent risk factor for recurrence highlighting the importance of lymph node dissection.