Lobar versus sub-lobar surgery for pulmonary typical carcinoid, a population-based analysis

The optimal surgery for resectable pulmonary typical carcinoid (TC), e.g., lobar resection (L-R)The Surveillance, Epidemiology, and End Results (SEER) Program was used to select patients ≥66 years old, and diagnosed between 2000 and 2012 with pulmonary TC. A similar cohort was developed using the SEER-Medicare database (diagnosed from 2000-2007) to identify chemotherapy (CTX) use and co-morbidity. Five-year survival was calculated using univariate and multivariate analysis.A total of 1,506 and 512 patients were identified from SEER and SEER-Medicare, respectively. In the SEER cohort, 49%, 29% and 21% received L-R, SL-R, and no surgery (NS), respectively. Those who received NS were older (P0.001), had a higher stage (P0.001), greater comorbidity (P0.001), and were more likely to receive radiotherapy (XRT) (P0.001) and CTX (P0.001). Relative survival was nearly 100% for those who received L-R or SL-R as opposed to 72% for those who received NS (P0.001). Cox models showed no survival difference for L-RSL-R was better than NS, and similar to L-R in terms of survival. SL-R should be considered over NS if L-R is unfeasible. Role of adjuvant CTX and XRT is unclear as these did not improve survival in this study.