Major lung resection for carcinoid tumor; Does it affect quality of life?

Background: Pulmonary carcinoid is rare with surgery remaining the gold standard treatment which may include radical lung resection as well as minimally invasive procedures and parenchymal sparing bronchial resection. However, resection may impact patients' daily activities due to decreased lung volume reserve and postoperative pain. Our study aims to compare the impact of different types of surgical resection on the post-operative quality of life with the application of a strict peri-operative pulmonary care program. Methods: : Patients who underwent surgery for bronchopulmonary carcinoid tumors in a tertiary cancer center between August, 2017 and March, 2020 were included. For the qualitative and quantitative assessment of pain and quality of life, we utilized the Arabic version of Short-form McGill Pain Questionnaire and Activity of Daily Living (ADL) instrument respectively. Lung reserve was assessed before and after surgery. Statistical analysis conducted on SPSS version 24. Results: : A total of 16 patients underwent different type of resection. The majority were males (n=10; 63%) with a mean age of 44 years (19-81). Most common clinical stage was stage I (n=12, 75%) with typical carcinoid features recorded in more than half of the cases (n=11, 69%). Almost all patients underwent surgical excision (n=15, 94%) with negative resection margin and no major post-operative complications. Bilobectomy was the most frequent procedure (n=6, 40%) and video-assisted thoracoscopic surgery (VATS) was utilized in 8 patients (50%). Expected changes were recorded in pre- and postoperative pulmonary function test. The majority of patients (n=15, 94%) were totally independent. Mild intermittent pain was found in 7 patients (44%) who scored an average intensity of 1.6 out of 10. Conclusions: : Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoid tumors with little to no effect on patients' lung function and quality of life in regard to performance status and post-operative pain when a good peri-operative pulmonary, physical rehabilitation, and pain management programs are adopted and strictly implemented.