Pulmonary Neuroendocrine Tumor
ICD-10 C34.9 · ICD-11 2C25.4

Treatment of Lung Carcinoid (Typical or Atypical), UICC TNM Stage I–III — Localised and Resectable

This protocol covers the management of pulmonary neuroendocrine tumors presenting as lung carcinoid — both typical (TC) and atypical (AC) histology — at UICC TNM stage I, II, or III, where disease is localised and surgically resectable, including cases with N2 lymph nodal involvement.

Clinical Scenario

Patients with a lung carcinoid (typical or atypical), staged I through III by UICC TNM criteria, with localised, resectable disease. Upfront surgical management is addressed, including situations where prior biopsy was unsuccessful or where the tumour carries an elevated risk of bleeding or hormonal crisis.

Treatment Approach
Where a functioning syndrome is present, it is addressed before any invasive intervention. The core strategy centres on anatomic pulmonary resection combined with systematic lymph node evaluation, with the choice of specific procedure guided by tumour location and surgical considerations.

The complete protocol specifies preferred resection types, required nodal station coverage, bronchoplastic indications, and management decision points — all accessible via the link below.

Instant Access to Structured Evidence-Based Regimens
References
DOI: 10.1016/j.annonc.2021.01.003
  • Surgery represents the treatment of choice for LCs (both TCs and ACs), even in the case of N2 lymph nodal metastases [IV, A].
  • Surgery may be carried out upfront after adequate medical preparation in localised resectable tumours resembling LCs or in tumours considered at high risk of bleeding or hormonal crisis or when previous biopsy has failed.
  • Control of a functioning syndrome must be considered before any invasive therapeutic intervention [V, A].
  • Anatomic pulmonary resection (e.g. segmentectomy, lobectomy, bilobectomy, pneumonectomy) and lymph node resection (with a minimum of six nodal stations: three hilar and three mediastinal — also including subcarinal station — as recommended by the European Society of Thoracic Surgery for non-small-cell lung cancer) is the preferred extent of resection [IV, B].
  • Bronchoplastic procedures (e.g. sleeve resections) are preferred for suitable centrally located tumours, with the aim of avoiding pneumonectomy [IV B].
  • Systematic lymph node dissection is recommended as lymph node metastases may be observed in up to 27% of TCs and in up to 47% of ACs, and lymph node resection influences the prognosis and the modality of follow-up [IV, B].
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