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Dan J. Raz, MD
Author and Funding Information

FUNDING/SUPPORT: This work was supported by the National Cancer Institute of the National Institutes of Health [Grant NIH 5K12CA001727-20].

FINANCIAL/NONFINANCIAL DISCLOSURE: The author has reported to CHEST the following: D. J. R. has served as a consultant for Cireca LLC.

CORRESPONDENCE TO: Dan J. Raz, MD, Division of Thoracic Surgery, City of Hope Medical Center, 1500 E Duarte Rd, Duarte, CA 91010


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):284-285. doi:10.1016/j.chest.2015.09.031
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We thank Scarlata and colleagues for their insightful comments regarding the use of endoscopic techniques in the management of central typical carcinoid tumors as well as their comments on our recent article. As mentioned in their letter, there are institutional series reporting excellent long-term results with endoscopic management., We did not provide information on endoscopic management in our article because the number of patients was small and we had limited information from the Surveillance, Epidemiology, and End Results Program database. We used these data to assess whether procedures were diagnostic or therapeutic, the specific treatment provided, and the number of times endoscopic procedures were performed for each patient.

Endoscopic procedures for central carcinoid tumors carry several pitfalls. First, lymph node status is not determined. A small proportion of patients with typical carcinoid tumors will have occult lymph node metastasis, which can affect long-term prognosis. Second, there are risks of procedural bleeding, and we recommend that endoscopic management of carcinoids should be performed only by pulmonologists and surgeons skilled in the management of endoscopic bleeding complications. Finally, endoscopic management may require repeated procedures over a patient’s lifetime. The need for repeated procedures should be factored into the treatment plans, particularly in patients with a long life expectancy. We agree that additional investigation comparing endoscopic and surgical management of central carcinoid tumors is needed. Until additional data are available, however, we recommend that surgical treatment be the first-line therapy in patients with acceptable operative risk, and treatment should be performed by surgeons experienced with sleeve bronchial resections.

References

Raz D.J. .Nelson R.A. .Grannis F.W. .Kim J.Y. . Natural history of typical pulmonary carcinoid tumors: a comparison of nonsurgical and surgical treatment. Chest. 2015;147:1111-1117 [PubMed]journal. [CrossRef] [PubMed]
 
Brokx H.A. .Risse E.K. .Paul M.A. .et al Initial bronchoscopic treatment for patients with intraluminal bronchial carcinoids. J Thorac Cardiovasc Surg. 2007;133:973-978 [PubMed]journal. [CrossRef] [PubMed]
 
Luckraz H. .Amer K. .Thomas L. .et al Long-term outcome of bronchoscopically resected endobronchial typical carcinoid tumors. J Thorac Cardiovasc Surg. 2006;132:113-115 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Raz D.J. .Nelson R.A. .Grannis F.W. .Kim J.Y. . Natural history of typical pulmonary carcinoid tumors: a comparison of nonsurgical and surgical treatment. Chest. 2015;147:1111-1117 [PubMed]journal. [CrossRef] [PubMed]
 
Brokx H.A. .Risse E.K. .Paul M.A. .et al Initial bronchoscopic treatment for patients with intraluminal bronchial carcinoids. J Thorac Cardiovasc Surg. 2007;133:973-978 [PubMed]journal. [CrossRef] [PubMed]
 
Luckraz H. .Amer K. .Thomas L. .et al Long-term outcome of bronchoscopically resected endobronchial typical carcinoid tumors. J Thorac Cardiovasc Surg. 2006;132:113-115 [PubMed]journal. [CrossRef] [PubMed]
 
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