Pneumonectomy in bronchial carcinoid tumors

Bronchial carcinoids (BCs) are a part of the Lung Neuroendocrine Tumors group, and account for approximately 0.4% to 3% of all lung malignancies in adults. They have been classified as typical (TC) and atypical carcinoid (AC), according to their different histological and biological characteristics. The anatomic BC distribution is slightly different: in approximately 85% of cases TC is centrally located (typically defined as visible by the bronchoscopy), versus 15% only AC. Surgery (with the aim of a complete tumor resection, preserving as much lung parenchyma as possible, along with a systematic lymphadenectomy) represents the standard of care for BC's treatment. In recent years, and based on different clinical experiences, the role of pneumonectomy in central tumors has been deeply revised, following the increasingly frequent use of bronchoplasty and sleeve lobectomy. Bronchial sleeve or sleeve lobectomy demonstrated to have the same survival of classic anatomical surgical resections offered for other primary lung cancers. The absence of neoplastic cells in the bronchial resection margins intraoperative histological confirmation represents the necessary condition to confirm the oncological radicality of these procedures. Furthermore, following the recent guidelines, any lung resection for BCs must necessarily be accompanied by a systematic lymphadenectomy, as in the case of primary lung cancers. Aim of this article is to review the indications for surgical resections, especially emphasizing the role of limited resections and the possible endobronchial treatment for centrally located tumors.