This large, retrospective study (1997–2023) found that surgical resection offers a significant survival benefit for both stage III and stage IV pulmonary carcinoid tumors, including those with metastatic disease. Surgery reduced mortality risk in both stages, regardless of histologic subtype, and survival rates were similar after lobectomy or sublobar resection. Atypical histology and the presence of multiple metastases were associated with worse outcomes. Chemotherapy and radiotherapy did not provide additional survival benefits. These findings, supported by SEER database analyses, suggest that surgery should be considered even for advanced-stage or metastatic pulmonary carcinoid tumors, challenging current conservative guidelines.