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Ann Thorac Surg 2001;71:386-393
© 2001 The Society of Thoracic Surgeons

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Current review

Giant bronchial carcinoid tumors: a multidisciplinary approach

^a Department of Anaesthesia, The Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
^b Department of Radiology, The Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
^c Departments of Laboratory Medicine and Pathobiology, The Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Address reprint requests to Dr Keshavjee, Division of Thoracic Surgery, The Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, ON, Canada M5G 2C4
e-mail: shaf.keshavjee{at}uhn.on.ca

Background. Bronchial carcinoid tumors account for approximately 2% of all lung tumors. Although they were considered benign lesions, they are now categorized malignant, occasionally with poor prognosis. The clinical symptoms can be highly variable and are often present for many years before diagnosis. Whereas some carcinoids are entirely asymptomatic, others are accompanied by carcinoid or paraneoplastic syndromes.

Methods. We describe the multidisciplinary management of a 34-year-old female patient with a massive actively secreting bronchial carcinoid tumor of the right lung. Furthermore, we provide a review of the literature regarding the operative treatment and the perioperative management of pulmonary carcinoid tumors with respect to surgical, anesthetic, radiologic, and pathologic considerations.

Results. In the reported case, the first symptoms were chronic watery diarrhea, skin flushing, progressive shortness of breath, and increasing right shoulder pain. When the patient initially presented at our institution, the tumor had already reached an enormous size and it involved the right and left atrium as well as the atrial septum. Using an evidence-based, multidisciplinary approach the patient was treated successfully with extended surgical resection.

Conclusions. Carcinoid tumors are potentially curable even if they reach a significant size and thus an aggressive strategy is warranted. The management of such cases requires careful investigation, planning, and treatment with collaborative expertise provided by a multidisciplinary team. We demonstrated that this approach can lead to a favorable outcome in what first appeared to be a formidable and unresectable tumor.

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