Features of preparation and surgical aspects of treatment of patients with ACTH-producing neuroendocrine lung tumors

BACKGROUND: The Department of Thoracic Surgery of the National Medical Research Center of Surgery named after A. V. Vishnevsky has been dealing with the problem of surgical treatment of patients with neuroendocrine lung tumors for more than 20 years. This article presents the experience of treating patients with ectopic ACTH syndrome over the past 15 years.

AIM: To study the features of preparation, surgical aspects of treatment and delayed results in patients with ACTH-producing tumors of bronchopulmonary localization.

MATERIALS AND METHODS: The study included 55 patients who underwent surgical treatment of ACTH-producing neuroendocrine tumor of bronchopulmonary localization in the period from 2005 to 2020. In order to systematize the approach to surgical treatment and the choice of the type of operation, a point analysis of the patient’s severity has been developed. Demographic information about patients, anamnesis data, results of hormonal and instrumental studies at pre- and postoperative stages and long-term treatment results were analyzed. The control period of observation of patients after surgery ranged from 6 months to 5 years.

RESULTS: The age of the patients ranged from 18 to 72 years (36±15). According to the MSCT results of the chest, neoplasms in the lungs ranging in size from 5 to 25 mm were detected. Patients who scored from 18 to 23 points had lung resection due to the severity of the condition. With a total score from 14 to 18, segmentectomy with lymph node dissection was performed. When the total score was less than 14, a lobectomy with lymph node dissection was performed. During the planned histological examination, lung neuroendocrine tumor of various differentiation degree was confirmed in all patients. The results of treatment were followed in the period from 6 to 60 months, with a median of 19 months [10;24]. Regression of clinical manifestations of hypercortisolism after 1 year of dynamic follow-up period was detected in 83% of patients. After 60 months of follow-up 10 patients (71.4%) had a persistent clinical effect after surgical treatment with complete regression of hypercortisolism symptoms.

CONCLUSION: The analysis of the results of surgical treatment, according to the proposed methodological aspects, with dynamic control after 6, 12 and 36 months showed the effectiveness of such surgical intervention with results comparable to the world indicators of leading clinics.

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