Afoke and coworkers recently addressed the following question ‘Is sublobar resection equivalent to lobectomy for surgical management of peripheral carcinoid?’ [1]. Using a search strategy based on keywords ‘carcinoid tumour’ and ‘pulmonary surgical procedures’ the authors selected 10 articles to provide the best evidence to answer the question. Since the classification into two distinctive forms, typical (TC) and atypical carcinoids (AC), has changed over the years, this selection is, however, questionable. Indeed, in 1998, Travis and coworkers proposed new criteria for AC and its separation from TC. Based on these new criteria, the World Health Organization (WHO) established a definitive classification of pulmonary neuroendocrine tumours in 1999, which was confirmed in 2004. Consequently, in series of carcinoid tumours classified according to the old classifications (before 1999) there are some overlaps among the two entities (TC vs AC) in comparison with the definitive classification, leading to possible misleading factor in the Afoke and coworkers' study. In our opinion the series published before 1999 might be discarded to determine the long-term survival and disease recurrence such as we had done in a previous study in the field [2]. In fact, in the Afoke and coworkers' selection, there are only three valuable articles to address the question: the article by Chen and coworkers reporting a small group of patients included between 2000 and 2009 [1]; and two articles including patients before 1999, in which the pathology slide blocks were reviewed for reclassification according to the 1999 WHO criteria for neuroendocrine tumours [3, 4]. Finally, despite this limitation, the Afoke and coworkers' conclusion is in line with a recent study conducted in a large series of patients, in which the authors stated that ‘compared with lobectomy, sublobar resection is associated with non-inferior survival in patients with typical carcinoid of the lung’ [5].
Conflict of interest: none declared.
References
- 1.Afoke J, Tan C, Hunt I, Zakkar M. Is sublobar resection equivalent to lobectomy for surgical management of peripheral carcinoid. Interact CardioVasc Thorac Surg 2013;16:858–64 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wurtz A, Benhamed L, Conti M, Bouchindhomme B, Porte H. Results of systematic nodal dissection in typical and atypical carcinoid tumors of the lung. J Thorac Oncol 2009;4:388–94 [DOI] [PubMed] [Google Scholar]
- 3.Cardillo G, Sera F, Di Martino M, Graziano P, Giunti R, Carbone L, et al. Bronchial carcinoid tumors: nodal status and long-term survival after resection. Ann Thorac Surg 2004;77:1781–5 [DOI] [PubMed] [Google Scholar]
- 4.Rea F, Rizzardi G, Zuin A, Marulli G, Nicotra S, Bulf R, et al. Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients. Eur J Cardiothorac Surg 2007;31:186–91 [DOI] [PubMed] [Google Scholar]
- 5.Fox M, Van Berkel V, Bousamra M, II, Sloan S, Martin RC., II Surgical management of pulmonary carcinoid tumors: sublobar resection versus lobectomy. Am J Surg 2013;205:200. [DOI] [PubMed] [Google Scholar]