Cerrahi Rezeksiyon Sonrası Sonuçlarla, Pulmoner Karsinoid Tümörlerin Tedavi Protokollerinin ve Sağkalımın Araştırılması

Year 2018, Volume: 4 Issue: 3, 239 - 244, 01.01.2018

Hakan Keskin

Abstract

Amaç: Pulmoner karsinoid tümörler; akciğerler içinde nöroendokrin tipte olan Kultschitzky hücrelerinden kaynaklanan ve tüm akciğer tümörlerinin sadece %1-2ʼsini oluşturan malign neoplazmlardır.Çalışmada akciğer karsinoid tümörlerin klinik özellikleri, tedavi protokolleri ve prognostik faktörleri incelendi.Gereç ve Yöntemler: Geriye dönük çalışmaya kliniğimizde Ocak 2010 ile Temmuz 2017 tarihleri arasında patoloji raporları ile karsinoid tümör tanısı alan olgular dahil edildi. Hastaların cinsiyetleri, yaşları, şikâyetleri, tedavide uygulanan cerrahi teknik, hücre tipi, tümörün yerleşim yeri, tümör çapı, lenf nodu ve uzak organ metastaz varlığı, karşılaşılan komplikasyonlar ve sağkalım süreleri incelendi. Bulgular: Çalışmadaki 23 hastanın ortalama yaşları 49,5 ± 13,6’dı. Hastaların 15 %65,2 tanesi kadın 8 %34,8 tanesi erkekti. Hastaların 19 %82,6 tanesinde öksürük, balgam ve hemoptizi gibi solunum yolu semptomları mevcuttu. Tümör yerleşimi açısından bakıldığında en sık yerleşim yeri sağ alt lob %34,7 olarak bulundu. Yapılan cerrahi işlemler sonrasında hiçbir hastada mortalite ve morbidite izlenmedi. Sadece iki hastada lenf nodu veya uzak organ metastazı saptanmış olup bu hastaların atipik karsinoid tümör tanısı aldığı görüldü. Operasyon sonrası yirmibeşinci ve otuzbirinci aylarda atipik karsinoid tümör tanısı alan iki hasta eksitus oldu. Bunlardan bir tanesinde lenf nodu ve uzak organ metastazı saptanmıştı. Sonuç: Medikal tedaviye yanıt alınamayan öksürük, balgam ve nefes darlığı gibi semptomlarda karsinoid tümör tanısı düşünülmelidir. Cerrahi eksizyon sırasında cerrahi sınırlarda tümör kalmamasına özen gösterilmeli ve preoperatif tanısı ne olursa olsun her hastaya mediastinal lenf nodu disseksiyonu yapılmalıdır. Çalışmamızda sağkalımı belirleyen en önemli faktörlerin histolojik tip ve uzak organ metastazı ve lenf nodu tutulumu olduğu bulundu

Keywords

Akciğer, Atipik, Karsinoid, Sağkalım, Tipik

Investigation of Treatment Protocols and Survival of Pulmonary Carcinoid Tumors with Results After Surgical Resection

Abstract

Objective: Pulmonary carcinoid tumors are malignant neoplasms originating from Kultschitzky cells of the neuroendocrine type in the lungs and constituting only 1-2% of all lung tumors.The clinical features, treatment protocols and prognostic factors of lung carcinoid tumors were evaluated in this study.Material and Methods: This retrospective study included pathology reports and cases with a carcinoid tumor diagnosis between January 2010 and July 2017 in our clinic. The sex, age, complaints, surgical technique, cell type, site of tumor, tumor diameter, lymph node and distant organ metastasis, encountered complications, and survival time were analyzed.Results: The mean age of the 23 patients in the study was 49.5 ± 13.6 years. Fifteen 65.2% of the patients were female and 8 34.8% were male. Nineteen 82.6% of the patients had respiratory symptoms such as cough, sputum and hemoptysis.The most common site of tumor placement was the right lower lobe 34.7% . No mortality and morbidity were observed in any of the patients after the surgical procedures performed. Two patients who had atypical carcinoid tumor diagnosis at the twenty-fifth and thirty-first months postoperatively died. One of them had lymph node and distant organ metastasis. Lymph node or distant organ metastasis was found in only two patients and these patients were diagnosed with atypical carcinoid tumor. Conclusion: A carcinoid tumor diagnosis should be considered when symptoms such as cough, sputum and shortness of breath that cannot be resolved with medical treatment are present. During surgical excision, one must be careful not to leave tumor at the surgical margin and a mediastinal lymph node dissection should be performed in every patient regardless of the preoperative diagnosis. The most important factors determining survival in our study were histological type, lymph node involvement and distant organ metastasis.

Keywords

Atypical, Carcinoid, Lung, Survival, Typical

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