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Carcinoid tumours of the lung and the 'PEPPS' approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery.

Neuberger M, Hapfelmeier A, Schmidt M, Gesierich W, Reichenberger F, Morresi-Hauf A, Hatz RA, Lindner M - BMJ Open Respir Res (2015)

Bottom Line: Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking.The effect was measured by the number of segments removed.Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the Ludwig Maximilian University , Munich , Germany.

ABSTRACT

Background: Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking.

Methods: In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival.

Results: 132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups.

Conclusions: After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates.

No MeSH data available.


Related in: MedlinePlus

Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (“PEPPS”). (A) Centrally located, endoluminal growing carcinoid tumour, diagnosed by CT. (B) Endoscopic view of a bronchus obstructing carcinoid tumour in the medial lobe bronchus before segment 4/5. (C) Bronchial view immediately after cryoablation and laser intervention. (D) The same bronchus in a bronchoscopic control 2 months after intervention before surgery.
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BMJRESP2015000090F2: Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (“PEPPS”). (A) Centrally located, endoluminal growing carcinoid tumour, diagnosed by CT. (B) Endoscopic view of a bronchus obstructing carcinoid tumour in the medial lobe bronchus before segment 4/5. (C) Bronchial view immediately after cryoablation and laser intervention. (D) The same bronchus in a bronchoscopic control 2 months after intervention before surgery.

Mentions: Prior to surgery, 57 of these patients (51.8%) received the preoperative bronchoscopic treatment for tumour reduction. Images from PEPPS are shown in figure 2. Surgery was initiated after a median of 20 days (range 0–270). 49 patients (44.5%) received a class 1 resection (40 lobectomies, 5 bilobectomies, 4 pneumonectomies) and 61 patients (55.5%) received a class 2 resection (25 sleeve lobectomies, 16 main bronchial sleeve resections and 20 segment resections; figure 3). No operative or postoperative mortality was seen.


Carcinoid tumours of the lung and the 'PEPPS' approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery.

Neuberger M, Hapfelmeier A, Schmidt M, Gesierich W, Reichenberger F, Morresi-Hauf A, Hatz RA, Lindner M - BMJ Open Respir Res (2015)

Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (“PEPPS”). (A) Centrally located, endoluminal growing carcinoid tumour, diagnosed by CT. (B) Endoscopic view of a bronchus obstructing carcinoid tumour in the medial lobe bronchus before segment 4/5. (C) Bronchial view immediately after cryoablation and laser intervention. (D) The same bronchus in a bronchoscopic control 2 months after intervention before surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4505362&req=5

BMJRESP2015000090F2: Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (“PEPPS”). (A) Centrally located, endoluminal growing carcinoid tumour, diagnosed by CT. (B) Endoscopic view of a bronchus obstructing carcinoid tumour in the medial lobe bronchus before segment 4/5. (C) Bronchial view immediately after cryoablation and laser intervention. (D) The same bronchus in a bronchoscopic control 2 months after intervention before surgery.
Mentions: Prior to surgery, 57 of these patients (51.8%) received the preoperative bronchoscopic treatment for tumour reduction. Images from PEPPS are shown in figure 2. Surgery was initiated after a median of 20 days (range 0–270). 49 patients (44.5%) received a class 1 resection (40 lobectomies, 5 bilobectomies, 4 pneumonectomies) and 61 patients (55.5%) received a class 2 resection (25 sleeve lobectomies, 16 main bronchial sleeve resections and 20 segment resections; figure 3). No operative or postoperative mortality was seen.

Bottom Line: Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking.The effect was measured by the number of segments removed.Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the Ludwig Maximilian University , Munich , Germany.

ABSTRACT

Background: Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking.

Methods: In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival.

Results: 132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups.

Conclusions: After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates.

No MeSH data available.


Related in: MedlinePlus