title: Combined Bronchial Artery Embolization and Endobronchial Resection for Bronchial Carcinoid: A Safety and Feasibility Pilot Study.
abstract: BACKGROUND
  There is growing evidence to support bronchoscopic resection of well-circumscribed typical carcinoids. However, massive bleeding and risk of recurrence can potentially complicate this approach.
  
  
  OBJECTIVE
  The aim of this study was to assess the safety and feasibility of endobronchial resection of carcinoids preceded by bronchial artery embolization.
  
  
  METHODS
  Five patients with centrally located typical carcinoids were recruited, 4 with a curative intent and 1 for palliation of a carcinoid with mediastinal invasion. All patients underwent selective embolization of the feeding bronchial artery 24-48 h prior to endobronchial resection, which was performed with a rigid bronchoscope and neodymium:yttrium-aluminium-perovskite laser.
  
  
  RESULTS
  Minimal bleeding was noted during tumour resection. After a median (range) follow-up of 20 (14-48) months, only the case with segmental extension of the tumour had local recurrence, which was treated successfully using cryotherapy (with negative endobronchial biopsies since), and no cases of metastatic spread occurred. One patient, in whom the histopathological diagnosis was changed from typical to atypical carcinoid following resection, went on to have a surgical bilobectomy 3 months later. Extensive fibrosis was noted at the site of original tumour resection with no evidence of residual disease.
  
  
  CONCLUSIONS
  Bronchial artery embolization prior to endobronchial resection of centrally located carcinoids is feasible and safe. The reduction in bleeding may facilitate and simplify the procedure. The possible application of this combined therapy to the management of atypical carcinoids warrants the design of a larger prospective clinical trial.
authors.affiliation: Department of Respiratory Medicine, Bellvitge Hospital, Barcelona, Spain.
authors.forename: Matthew
authors.initials: M
authors.lastname: Salamonsen
authors.forename: Rachid
authors.initials: R
authors.lastname: Tazi-Mezalek
authors.forename: Rosa
authors.initials: R
authors.lastname: López-Lisbona
authors.forename: Noelia
authors.initials: N
authors.lastname: Cubero
authors.forename: Núria
authors.initials: N
authors.lastname: Baixeras
authors.forename: Joan
authors.initials: J
authors.lastname: Dominguez
authors.forename: Jordi
authors.initials: J
authors.lastname: Dorca
authors.forename: Antoni
authors.initials: A
authors.lastname: Rosell
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001981:Bronchial Arteries; D001984:Bronchial Neoplasms / Q000628:therapy*; D001999:Bronchoscopy / Q000379:methods*; D002276:Carcinoid Tumor / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome