HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark K. Ferguson Rodney J. Landreneau Stephen R. Hazelrigg Nasser K. Altorki Keith S. Naunheim Joseph B. Zwischenberger Anthony P.C. Yim Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ferguson, M. K. Articles by Yim, A. P.C. Search for Related Content PubMed PubMed Citation Articles by Ferguson, M. K. Articles by Yim, A. P.C.

Eur J Cardiothorac Surg 2000;18:156-161
© 2000 Elsevier Science NL

Long-term outcome after resection for bronchial carcinoid tumors

^a Department of Surgery, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
^b Allegheny General Hospital, Pittsburgh, PA, USA
^c Southern Illinois University, Springfield, IL, USA
^d The New York Hospital-Cornell Medical Center, New York, NY, USA
^e St. Louis University, St. Louis, MO, USA
^f University of Texas Medical Branch, Galveston, TX, USA
^g The Chinese University of Hong Kong, Hong Kong, China

Received 7 September 1999; received in revised form 3 May 2000; accepted 16 May 2000.

Corresponding author. Tel.: +1-773-702-3551; fax: +1-773-702-2642
e-mail: mferguso{at}surgery.bsd.uchicago.edu

	Abstract

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 
Objectives: We sought to determine the long-term survival of patients treated for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. Methods: We conducted a retrospective, multi-institutional review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgical complications, tumor recurrence, and long-term survival were assessed. Results: There were 50 men and 89 women with a mean age of 52.2±17.4 and 58.9±13.3 years, respectively (P=0.021). Men were more likely to be current or former smokers than were women. Operations included lobectomy or bilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronchial sleeve resection only in three patients; resection was performed thoracoscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid tumors were stage I in 100 and more advanced (stages II–IV) in nine, whereas atypical carcinoid tumors were stage I in 18 and more advanced in eight (P=0.002). Median follow-up was 43 months (range 1–149) during which 21 (15%) patients died (four from recurrent cancer) and 19 patients (14%) were lost to follow-up. Recurrent cancer developed in 2/98 patients with typical and 5/25 patients with atypical subtypes (P<0.001; log-rank test). The likelihood of recurrence was related to histological subtype (relative risk 7.9 for atypical carcinoid; 95% confidence interval 1.4–43.5). Five-year survival was 88% for stage I patients and was 70% for patients with more advanced stages. When stratified by stage, survival was related to age (relative risk=1.9 for a 10 year increase in age; 95% confidence interval 1.2–2.9) and possibly to the histological subtype, but not to patient gender, year of operation, or type of operation performed. Conclusions: Either major lung resection or wedge resection is appropriate treatment for patients with early stage typical bronchial carcinoid tumors. Survival is favorable for early stage tumors regardless of histological subtype. Local recurrence is more common among patients with atypical subtypes, suggesting that a formal resection may improve long-term outcome.

Key Words: Bronchogenic carcinoma • Bronchial carcinoid • Lung resection • Typical carcinoid • Atypical carcinoid • Thoracoscopy

	1. Introduction

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 
Bronchial carcinoid tumors comprise 25% of all carcinoid tumors but only 5% of all primary lung cancers [1,2]. This relative rarity makes their prospective study difficult. Most published reports of large numbers of surgically treated bronchial carcinoid tumors result from retrospective analyses of several decades of patient information from a single institution, and in many cases some of the management techniques are no longer utilized. Issues regarding pulmonary neoplasms that currently are of concern to the thoracic surgeon include the effect of operations other than formal lobectomy or pneumonectomy on local recurrence and long-term survival, and the appropriate place of video-assisted thoracic surgical techniques in their management. We performed a multi-institutional retrospective analysis of contemporary surgical management of bronchial carcinoid tumors to address these issues.

	2. Methods

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 
We retrospectively reviewed patients with an initial primary bronchial carcinoid tumor who underwent resection at any of the participating institutions from January 1980 to December 1998. Data forms were designed and were sent to the seven participating institutions to be completed by chart review or from existing databases. Patients were evaluated with a history and physical examination, posteroanterior and lateral chest radiographs, and computed tomographic (CT) scans of the chest and upper abdomen (including the liver and adrenal glands) beginning in 1983. Bone scintigrams and brain CT scans were performed in cases of bone pain, or neurological symptoms or signs. Performance status was assessed using the Karnovsky scale [3]. Pulmonary function tests including a calculation of single breath diffusing capacity for carbon monoxide were performed routinely. All patients had a preoperative or intraoperative bronchoscopic examination. Patients were resected using techniques appropriate to each patient's age, performance status, and individual tumor at the discretion of the surgeon. Assignment into typical or atypical histologic subtypes was performed according to standard criteria [4,5]. Pathologic staging was performed using the American Joint Committee on Cancer (AJCC) staging system [6].

Operative complications were classified as pulmonary (postoperative mechanical ventilation >24 h or reintubation for ventilatory support after the day of surgery, pneumonia defined as fever, leukocytosis, and pulmonary infiltrate requiring antibiotic therapy, air leak from thoracostomy tubes for more than 7 days postoperatively, and lobar collapse on postoperative chest radiograph), cardiovascular (new requirements for ß-blockers, calcium channel inhibitors, or vasodilating agents, the need for postoperative inotropic support other than renal dose dopamine, pulmonary embolism, myocardial infarction, and arrhythmia), other (wound infection, empyema, recurrent nerve injury, bronchopleural fistula, and other miscellaneous conditions), and death. Operative mortality was defined as death during hospitalization for lung resection, or any death within 30 days of the operation.

Follow-up usually was performed through periodic clinic visits until the patient's death. In some patients contact was established through the treating physician and/or the patient by mail or by telephone. Follow-up was considered complete if it extended to death or until within 1 year of analysis (December 1998) in survivors.

Patients were evaluated for demographic, surgical, and pathologic variables and the distributions of these variables were compared using the ² test or Fisher's exact test for discrete variables and unpaired Student's t-test for continuous variables. Data are presented as mean±SD. Survival and tumor recurrence were measured from the date of operation. Survival and tumor recurrence rates were calculated according to the Kaplan–Meier method [7]. Differences in survival and disease-free survival were tested for significance using the log-rank test [8]. A Cox proportional hazards model was fit in a stepwise manner to examine and adjust for the effects of surgery and other covariates on survival and disease-free survival [9]. All analyses were performed using either Minitab 12.0, Minitab, Inc., State College, PA, or Systat 8.0, SPSS, Inc., Chicago, IL. Data are expressed as mean±SD.

	3. Results

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 
There were 50 men and 89 women with a mean age of 56.4±15.2 years (range 13–84; Table 1). Men were younger than women and there was a significant age difference comparing groups of patients with typical and atypical histologic subtypes. The distribution of typical and atypical histologic subtypes among men and women was similar (41/8 for men, 68/18 for women; histologic subtype was unknown in 3 patients; P=0.5). Performance status did not differ between sexes or between histologic subtypes. Men were more likely to be current or former smokers than were women, but there was no correlation between tobacco use and histologic subtype. Spirometric values and diffusing capacity did not differ between sexes or histologic subtypes.

View larger version (13K): [in this window] [in a new window]   Fig. 1. Disease-free survival in patients undergoing resection for bronchial carcinoid tumors comparing those with typical (solid line) to those with atypical (dashed line) histological subtypes (P<0.001). Hash marks represent censored data.

View larger version (14K): [in this window] [in a new window]   Fig. 2. Survival in patients undergoing resection for bronchial carcinoid tumors comparing those with stage I (solid line) to those with stages II, III, and IV (dashed line) disease (P=0.16). Hash marks represent censored patients.

View larger version (14K): [in this window] [in a new window]   Fig. 3. Survival in patients undergoing resection for bronchial carcinoid tumors comparing those with typical (solid line) to those with atypical (dashed line) histologic subtypes (P=0.021). Hash marks represent censored patients.

	4. Discussion

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

Our overall findings are similar to those that have been reported previously. Bronchial carcinoid tumors occur in patients that are on average a decade younger than patients with non-small cell lung cancer, and are more often found in women than in men [2]. These tumors are not associated with tobacco use nearly as often as are non-small cell lung cancers, and the incidence of tobacco use does not appear to be related to the histologic aggressiveness of the disease [12]. Most tumors are localized and the likelihood of local recurrence after resection is small. This resulted in a 5-year survival of nearly 90% in patients with localized disease and 70% in patients with regionally advanced or metastatic disease in our study, values that are similar to those previously reported [2,10–12,14].

The assessment of the biological aggressiveness of bronchial carcinoid tumors is not always accurate. We and others have found that atypical carcinoid tumors present more often at a more advanced stage, are more likely to recur regardless of stage, and are associated with a decreased 5-year survival compared to typical carcinoid tumors [5,11,12,14,15]. These findings underscore the need for accurate differentiation between histologic subtypes. However, the reproducibility of the distinction between typical and atypical subtypes by experienced lung pathologists is not optimal, suggesting that more strict application of classification criteria is needed and perhaps that revision of classification criteria is also necessary [5,16]. Other techniques for estimating the aggressiveness of individual tumors that have been proposed include immunohistochemical analysis (heparin-binding lectin, binding of macrophage migration inhibitory factor and beta-N-acetyl-D-galactosamine), measurement of DNA ploidy, and assessment of chromosomal deletions (11q, 3p), but none of these has been shown to be useful preoperatively or intraoperatively to guide selection of surgical therapy [15,17–20]. Currently the only reliable factors for assessing aggressiveness are the tumor stage and the histologic subtype.

Newer modalities for staging bronchial carcinoid tumors that have recently been introduced include positron emission tomography (PET) and octreotide scintigraphy. PET imaging of bronchial carcinoid tumors demonstrates lower uptake than for non-small cell lung cancers, suggesting that differentiation of a solitary carcinoid tumor from a benign process and that staging of regional lymph nodes might be unreliable [21]. Scintigraphy with ¹¹¹In-octreotide has demonstrated reliable uptake in primary tumors and the ability to detect early recurrences and metastases even in asymptomatic patients, suggesting it might be a useful tool for routine staging in the future [22]. At present, however, decisions regarding appropriate therapy for patients with bronchial carcinoid tumors are made on the basis of histologic findings, clinical staging with bronchoscopy and computed tomography, and in some instances on intraoperative lymph node staging.

The appropriate surgical management of bronchial carcinoid tumors is suggested by the recurrence and survival patterns we and others have described [5,10,13,23–27]. Limited resections such as wedge resection or segmentectomy for peripheral tumors and isolated bronchial sleeve resection or sleeve lobectomy for proximal tumors should be considered when feasible for early stage typical bronchial carcinoid tumors because local recurrence is unlikely and survival is excellent. We did not investigate the use of endobronchial laser therapy for localized proximal typical carcinoids as part of this study. In our institutions this modality is used rarely and is reserved for patients who are medically unfit for resection. Given the excellent results of standard surgical therapy for such tumors and the risk of local recurrence when laser modalities are used, we strongly favor resection except in patients who are deemed to be at excessive risk.

There are insufficient data in our review, and there is no extensive published experience, to permit an informed commentary on the utility of video-assisted thoracic surgical techniques in patients with bronchial carcinoid tumors. Nevertheless, given our experience, such an approach seems both feasible and appropriate for peripheral early stage typical carcinoid tumors.

Long-term survival and local recurrence are both unfavorably affected by the finding of atypical histology. Our data suggest that a more aggressive surgical approach including formal lobectomy (or pneumonectomy when indicated) and lymph node dissection should be performed when this histology is identified. The potential benefit of postoperative adjuvant chemotherapy and/or radiation therapy also should be considered.

	Footnotes

 
Presented at the 13th Annual Meeting of the European Association for Cardio-thoracic Surgery, Glasgow, Scotland, UK, September 5–8, 1999.

	Appendix A Conference discussion

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 
Dr A. Chapelier (Les Plessis Robinson, France): I would like to ask you, because it is a little confusing, do you use the classification of Warren and Gould when you define atypical carcinoid?

And the second question, I was a little surprised at the few number of cases of sleeve resection in your series. Could you tell us a little more, please.

Dr Ferguson: We used the WHO classification for these tumors. The selection of sleeve resection is left up to the individual surgeon. Our data come from seven different centers, and there was quite a bit of variety in the surgical approaches used. It's fair to say that most of the centers don't favor bronchial sleeve resections quite as much as in some of the centers with higher volume pulmonary surgery.

Mr P. Goldstraw (London, UK): As you know, we presented our experience earlier in this meeting with rather similar numbers, and I think broadly similar experience, but coming from a single unit over a 20-year period. One of the surprises for us in that retrospective analysis was the very large number of cases we had to exclude on pathology review, which despite being initially classified by a pulmonary pathologist as carcinoid, whether typical or atypical, on review by a single pathologist, they were reclassified as large cell neuroendocrine carcinomas. Did you obtain central pathological review of all your cases? And could you tell us how many cases you had to exclude?

Dr Ferguson: Pathological analysis is a difficult and somewhat confounding factor. Obviously, in the very earliest studies of these patients, subtypes of neuroendocrine tumors hadn't been completely identified or widely accepted, but over the last 10 years or so the classification has been fairly straightforward on the basis of most experienced pathologists. Having said that, no, we don't have a central identification of tumor subtype and so have not specifically excluded any patients on the basis of a change in subtype.

Dr A. Lerut (Leuven, Belgium): Mark, if you want to figure out when a limited resection, a wedge resection, is acceptable, then I presume that you should try to find out the incidence of intralobar microscopic tumor in the infected lobe. First like has been done for non-small cell carcinoma. Do you have any idea about this?

Dr Ferguson: That's an important point and I agree with your comment. There are no data. We weren't able to subclassify things to that extent.

Dr Lerut: You have now collected material enough to do such a study.

Dr Ferguson: Yes, that's correct.

Dr P. Vadasz (Budapest, Hungary): Did you use, and if you did, what kind of immunohistochemical staining did you use for the exact pathological identification? I think it's necessary for the exact identification of neuroendocrine tumors.

Dr Ferguson: I don't have that information.

	References

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A Conference discussion References

 

1. Davila D.G., Dunn W.F., Tazelaar H.D., Pairolero P.C. Bronchial carcinoid tumors. Mayo Clin Proc 1993;68:795-803.[Medline]
2. Modlin I.M., Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer 1997;79:813-829.[Medline]
3. Stanley K.E. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 1980;65:25-32.
4. Arrigoni M.G., Woolner L.B., Bernatz P.E. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg 1972;64:413-421.[Medline]
5. Travis W.D., Rush W., Flieder D.B., Falk R., Fleming M.V., Gal A.A., Koss M.N. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol 1998;22:934-944.[Medline]
6. Mountain C.F. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-1717.[Abstract/Free Full Text]
7. Kaplan E.L., Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481.
8. Kalbfleisch J.D., Prentice R.L. The statistical analysis of failure time data. New York: Wiley, 1980.
9. Cox D.R. Regression models and life tables. J R Stat Soc, Series B 1972;34:187-220.
10. Hurt R., Bates M. Carcinoid tumours of the bronchus: a 33 year experience. Thorax 1984;39:617-623.[Abstract/Free Full Text]
11. McCaughan B.C., Martini N., Bains M.S. Bronchial carcinoids. J Thorac Cardiovasc Surg 1985;89:8-17.[Abstract]
12. Harpole D.H., Feldman J.M., Buchanan S., Young W.G., Wolfe W.G. Bronchial carcinoid tumors: a retrospective analysis of 126 patients. Ann Thorac Surg 1992;54:50-55.[Abstract]
13. Schreurs A.J.M., Westermann C.J.J., van den Bosch J.M.M., Vanderschueren R.G.J.R.A., de la Riviere A.B., Knaepen P.J. A twenty-five-year follow-up of ninety-three resected typical carcinoid tumors of the lung. J Thorac Cardiovasc Surg 1992;104:1470-1475.[Abstract]
14. Perkins P., Kemp B.L., Putnam J.B., Jr, Cox J.D. Pretreatment characteristics of carcinoid tumors of the lung which predict aggressive behavior. Am J Clin Oncol 1997;20:285-288.[Medline]
15. Kayser K., Kayser C., Rahn W., Bovin N.V., Gabius H.J. Carcinoid tumors of the lung. J Surg Oncol 1996;64:99-106.
16. Travis W.D., Gal A.A., Colby T.V., Klimstra D.S., Falk R., Koss M.N. Reproducibility of neuroendocrine lung tumor classification. Hum Pathol 1998;29:272-279.[Medline]
17. El-Naggar A.K., Ballance W., Karim F.W., Ordonez N.G., McLemore D., Giacco G.G., Batsakis J.G. Typical and atypical bronchopulmonary carcinoids. Am J Clin Pathol 1991;95:828-834.[Medline]
18. Padberg B.C., Woenckhaus J., Hilger G., Beccu L., Jochum W., Range U., Kastendieck H., Schroder S. DNA cytophotometry and prognosis in typical and atypical bronchopulmonary carcinoids. Am J Surg Pathol 1996;20:815-822.[Medline]
19. Kovatich A., Friedland D.M., Druck T., Hadaczek P., Huebner K., Comis R.L., Hauck W., McCue P.A. Molecular alterations to human chromosome 3p loci in neuroendocrine lung tumors. Cancer 1998;83:1109-1117.[Medline]
20. Walch A.K., Zitzelsberger H.F., Aubele M.M., Mattis A.E., Bauchinger M., Candidus S., Prauer H.W., Werner M., Hofler H. Typical and atypical carcinoid tumors of the lung are characterized by 11q deletions as detected by comparative genomic hybridization. Am J Pathol 1998;153:1089-1098.[Abstract/Free Full Text]
21. Erasmus J.J., McAdams H.P., Patz E.F., Jr, Coleman R.E., Ahuja V., Goodman P.C. Evaluation of primary pulmonary carcinoid tumors using FDG PET. Am J Roentgenol 1998;170:1369-1373.[Abstract/Free Full Text]
22. Musi M., Carbone R.G., Bertocchi C., Cantalupi D.P., Michetti G., Pugliese C., Virotta G. Bronchial carcinoid tumours: a study on clinicopathological features and role of octreotide scintigraphy. Lung Cancer 1998;22:97-102.[Medline]
23. Stamatis G., Freitag L., Greschuchna D. Limited and radical resection for tracheal and bronchopulmonary carcinoid tumour. Eur J Cardio-thorac Surg 1990;4:527-532.[Abstract]
24. Marty-Ane C.-H., Costes V., Pujol J.-L., Alauzen M., Baldet P., Mary H. Carcinoid tumors of the lung: do atypical features require aggressive management?. Ann Thorac Surg 1995;59:78-83.[Abstract/Free Full Text]
25. Chughtai T.S., Morin J.E., Sheiner N.M., Wilson J.A., Mulder D.S. Bronchial carcinoid – twenty years’ experience defines a selective surgical approach. Surgery 1997;122:801-808.[Medline]
26. Shah R., Sabanathan S., Mearns J., Richardson J., Goulden C. Carcinoid tumour of the lung. J Cardiovasc Surg 1997;38:187-189.[Medline]
27. Ducrocq X., Thomas P., Massard G., Barsotti P., Giudicelli R., Fuentes P., Wihlm J.M. Operative risk and prognostic factors of typical bronchial carcinoid tumors. Ann Thorac Surg 1998;65:1410-1414.[Abstract/Free Full Text]

This article has been cited by other articles:

				S. N. Pinchot, K. Holen, R. S. Sippel, and H. Chen Carcinoid Tumors Oncologist, December 1, 2008; 13(12): 1255 - 1269. [Abstract] [Full Text] [PDF]

				M. Rugge, M. Fassan, R. Clemente, G. Rizzardi, L. Giacomelli, G. Pennelli, C. Mescoli, D. Segat, and F. Rea Bronchopulmonary Carcinoid: Phenotype and Long-term Outcome in a Single-Institution Series of Italian Patients Clin. Cancer Res., January 1, 2008; 14(1): 149 - 154. [Abstract] [Full Text] [PDF]

				A. P. Townshend, B. Lakshminarayanan, A. E. M. Ucar, Z. R. Chaudry, and J. P. Duffy Rare Pleural Recurrence of Typical Pulmonary Carcinoid Tumor 30 Years After Lobectomy Ann. Thorac. Surg., April 1, 2007; 83(4): 1523 - 1524. [Abstract] [Full Text] [PDF]

				F. Rea, G. Rizzardi, A. Zuin, G. Marulli, S. Nicotra, R. Bulf, M. Schiavon, and F. Sartori Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 186 - 191. [Abstract] [Full Text] [PDF]

				M. Garcia-Yuste, J. M. Matilla, A. Cueto, J. M. R. Paniagua, G. Ramos, M. A. Canizares, I. Muguruza, and Members of the Spanish Multi-centric Study of Neur Typical and atypical carcinoid tumours: analysis of the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 192 - 197. [Abstract] [Full Text] [PDF]

				E. Lim, Y. K. Yap, B. L. De Stavola, A. G. Nicholson, and P. Goldstraw The impact of stage and cell type on the prognosis of pulmonary neuroendocrine tumors J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 969 - 972. [Abstract] [Full Text] [PDF]

				T. C. Mineo, G. Guggino, D. Mineo, G. Vanni, and V. Ambrogi Relevance of Lymph Node Micrometastases in Radically Resected Endobronchial Carcinoid Tumors Ann. Thorac. Surg., August 1, 2005; 80(2): 428 - 432. [Abstract] [Full Text] [PDF]

				J K Ramage, A H G Davies, J Ardill, N Bax, M Caplin, A Grossman, R Hawkins, A M McNicol, N Reed, R Sutton, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours Gut, June 1, 2005; 54(suppl_4): iv1 - iv16. [Full Text] [PDF]

				P. L. Filosso, A. Arslanian, N. Palestini, A. Farnetti, M. Papotti, M. Bongiovanni, R. Giobbe, and E. Ruffini Thyroid metastasis after resection of atypical bronchial carcinoid J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1840 - 1843. [Full Text] [PDF]

				G. Cardillo, F. Sera, M. Di Martino, P. Graziano, R. Giunti, L. Carbone, F. Facciolo, and M. Martelli Bronchial carcinoid tumors: nodal status and long-term survival after resection Ann. Thorac. Surg., May 1, 2004; 77(5): 1781 - 1785. [Abstract] [Full Text] [PDF]

				M. Mezzetti, F. Raveglia, T. Panigalli, L. Giuliani, F. Lo Giudice, S. Meda, and S. Conforti Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification Ann. Thorac. Surg., December 1, 2003; 76(6): 1838 - 1842. [Abstract] [Full Text] [PDF]

				P. L. Filosso, O. Rena, E. Ruffini, A. Oliaro, and L. H. Harrison Intraoperative OctreoScan and Management of Bronchial Carcinoid Chest, October 1, 2002; 122(4): 1493 - 1494. [Full Text] [PDF]

				P. L. Filosso, O. Rena, G. Donati, C. Casadio, E. Ruffini, E. Papalia, A. Oliaro, and G. Maggi Bronchial carcinoid tumors: Surgical management and long-term outcome J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 303 - 309. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark K. Ferguson Rodney J. Landreneau Stephen R. Hazelrigg Nasser K. Altorki Keith S. Naunheim Joseph B. Zwischenberger Anthony P.C. Yim Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ferguson, M. K. Articles by Yim, A. P.C. Search for Related Content PubMed PubMed Citation Articles by Ferguson, M. K. Articles by Yim, A. P.C.