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J Thorac Cardiovasc Surg 2007;133:973-978
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Initial bronchoscopic treatment for patients with intraluminal bronchial carcinoids

Hes A.P. Brokx, MDa, Elle K. Risse, MD, PhDb, Marinus A. Paul, MD, PhDc, Katrien Grünberg, MD, PhDb, Richard P. Golding, MDd, Peter W.A. Kunst, MD, PhDa, Jan-Peter Eerenberg, MD, PhDc, Johan C. van Mourik, MDc, Pieter E. Postmus, MD, PhDa, Wolter J. Mooi, MD, PhDb, Tom G. Sutedja, MD, PhDa,*

a Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
b Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
c Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
d Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.

Received for publication August 30, 2006; revisions received December 1, 2006; accepted for publication December 12, 2006.

* Address for reprints: T. G. Sutedja, MD, PhD, Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. (Email: tg.sutedja{at}vumc.nl).

Objective: Carcinoid of the lung is considered low-grade malignancy, and less invasive treatment may therefore be considered. We analyzed the long-term outcome of initial bronchoscopic treatment in patients with intraluminal bronchial carcinoids.

Methods: Initial bronchoscopic treatment was applied to improve presurgical condition, to obtain tissue samples for proper histologic classification, and to enable less extensive parenchymal resection. For intraluminal bronchial carcinoid, complete tumor eradication with initial bronchoscopic treatment was attempted. High-resolution computed tomography in addition to bronchoscopy was used to determine intraluminal versus extraluminal tumor growth. Surgery followed in cases of atypical carcinoid, residue, or recurrence.

Results: Seventy-two patients, 43 of them female, have been treated (median age 47 years, range 16-80 years). Median follow-up has been 65 months (range 2-180 months). Fifty-seven (79%) had typical carcinoids and 15 (21%) had atypical carcinoids. Initial bronchoscopic treatment resulted in complete tumor eradication in 33 of 72 cases (46%), 30 typical and 3 atypical. Thirty-seven of 72 cases (51%), 11 atypical, required surgery (2 for late detected recurrences). Two patients had metastatic atypical carcinoid, 1 already at referral. Of the 6 deaths, 1 was tumor related.

Conclusions: Initial bronchoscopic treatment is a potentially more tissue-sparing alternative than immediate surgical resection in patients with intraluminal bronchial carcinoids. For successful tumor eradication with initial bronchoscopic treatment in central carcinoids, assessment of intraluminal versus extraluminal growth may be of much more importance than histologic division between typical and atypical carcinoid. Disease-specific mortality is low, and long-term outcome has been excellent. Implementation of initial bronchoscopic treatment had no negative impact on surgical treatment outcome.

Abbreviations and Acronyms AC = atypical carcinoid; BC = bronchial carcinoid; HRCT = high-resolution computed tomography; IBT = initial bronchoscopic treatment; TC = typical carcinoid




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