Impact of Surgical extent on survival in pulmonary typical carcinoids: a retrospective analysis

While surgical resection of pulmonary typical carcinoid is the primary curative treatment, the optimal extent of resection remains debated, with limited data on survival outcomes and prognostic factors guiding management. This study compared surgical resections of typical carcinoids and evaluated survival and recurrence rates. It also seeks to identify negative prognostic factors to improve the management. A single-center retrospective study analyzed data from patients who underwent surgery for typical carcinoid between 1998 and 2023. The surgery was divided into three groups: atypical segmentectomies, typical segmentectomies, and lobectomies. Clinical and pathological characteristics, perioperative outcomes, and survival rates were assessed. The survival curves were generated using the Kaplan-Meier method, and Cox regression analysis identified prognostic factors for overall survival (OS). Of the 524 patients, 187 (35.7%) were typical carcinoid. Among them, 20% underwent atypical segmentectomy, 3% underwent typical segmentectomy, and 77% underwent lobectomy. The 5-year OS rate was 86%. Recurrence was observed in two patients, all in the lobectomies. The number of mitoses (p = 0.026) and nodal metastases (p = 0.0002) were negative prognostic factors for OS. No significant difference between the surgical approaches was found for OS (Log-rank test = 0.48) or disease-free survival (DFS) (Log-rank test = 0.76). While lobectomy remains the most commonly performed procedure for typical carcinoid, none of the evaluated surgical approaches significantly influenced OS or DSF. Notably, mitoses and nodal metastases emerged as key negative prognostic factors.