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Results of Systematic Nodal Dissection in Typical and Atypical Carcinoid Tumors of the Lung

Background: To determine the lymphatic spread frequency and location in patients, who underwent lung resection for carcinoid tumors, associated with systematic nodal dissection. Methods: From January 1998 to June 2007, 54 patients underwent anatomic lung resection associated with systematic nodal dissection for tumors classified as typical (TC) or atypical carcinoid according to 1999 World Health Organization criteria. The number and location of the resected lymph nodes were specified. All patients were followed up. Results: All patients underwent complete resection (R0) that were anatomic in 32 patients (59.2%), and associated with a bronchoplastic procedure in 22 (40.8%). Low morbidity was related to lymphadenectomy. The mean number of resected lymph nodes was of 18 (range, 7–44) per patient, which pathologic studies demonstrated lymphatic spread in 10 patients (18.5%). In the TC group (n = 42) 2 patients were classified N1 (4.8%) and 4 N2 (9.5%). In the atypical group (n = 12) 2 patients were classified N1 (16.6%) and 2 N2 (16.6%). Five of the 6 N2 patients showed a single skip metastasis not discovered by preoperative evaluation (83.3%). The lymphatic spread was correlated with age ≤35 years (p = 0.01) and a tumor size ≥3 cm (p = 0.002). Median follow-up was 57 months. Nine patients with lymphatic spread are disease free and one died from metastatic disease at 52 months. Conclusion: Systematic nodal dissection showed a high frequency of unpredictable lymphatic spread, mainly in the TC group. This procedure is mandatory to treat carcinoids in a curative intent.