Wedge Resection Offers Similar Survival to Segmentectomy for Typical Carcinoid Tumors

• Published in: Seminars in thoracic and cardiovascular surgery Vol. 34; no. 1; pp. 293 - 298
• Main Authors: Bachman, Katelynn C., Worrell, Stephanie G., Linden, Philip A., Gray, Kelsey E., Argote-Greene, Luis Marcello, Towe, Christopher W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2022
• Subjects: Carcinoid Tumor - diagnostic imaging; Carcinoid Tumor - surgery; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms - pathology; Neoplasm Staging; Pneumonectomy - adverse effects; Pulmonary carcinoid; Retrospective Studies; Segmentectomy; Thoracic surgery; Treatment Outcome; Wedge resection; Thoracic surgery; Wedge resection; NCDB; Pulmonary carcinoid; Segmentectomy; WR; SR
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2021.03.005

Current guidelines recommend anatomic lung resection of typical bronchopulmonary carcinoids. Typical carcinoid tumors have excellent prognosis and sublobar resection has been associated with noninferior long-term survival. It's unclear whether wedge resection is acceptable for small typical carcinoid tumors. We hypothesize there is no difference in survival between wedge resection and segmentectomy for Stage I typical bronchopulmonary carcinoid tumors. Using the National Cancer Database from 2010 to 2016, we identified clinical T1N0M0 typical bronchopulmonary carcinoid tumors by wedge resection or segmentectomy. Short-term outcomes included length of stay, lymph nodes evaluated, pathologic node status, positive margin status, and 90-day mortality. Primary outcome was overall survival and estimated using Kaplan-Meier survival analysis. 821 patients were identified: 677 receiving wedge resection, 144 receiving segmentectomy. Segmentectomy was more commonly performed in an academic setting (70.0% vs 57.3%, P = 0.005). The mean tumor size for segmentectomy was 1.7 cm versus 1.4 cm for wedge resection (P < 0.001). There was no difference in LOS, positive margin status, and 90-day mortality between groups. There were significantly more lymph nodes evaluated in segmentectomy patients (median 4 vs 0, P < 0.001), but there was no difference in positive lymph node status (5.3% vs 2.6%, P = 0.165). The OS was similar between wedge and segmental resection (P = 0.613): 3-year survival (93.5% vs 92.8%) and 5-year survival (83.8% vs 84.9%). Wedge resection and segmentectomy have similar survival for Stage I typical bronchopulmonary carcinoids in a large national database. This analysis suggests nonanatomic, parenchymal-sparing resection should be considered an appropriate alternative for Stage I typical bronchopulmonary carcinoids.
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