Author Response for "endoscopic Resection of Benign Airway Tumors: A 21-Year Comparative Study Focusing on Endobronchial Hamartoma and Leiomyoma"

Background Endobronchial hamartoma and leiomyoma are rare benign airway tumors that may cause significant airway obstruction and require bronchoscopic intervention. However, comparative data on their clinical characteristics and interventional outcomes, particularly according to anatomic location, remain limited. Objectives The objective of this study was to compare the clinical characteristics and bronchoscopic resection outcomes of endobronchial hamartoma and leiomyoma, with a focus on the impact of airway location. Design This study was a retrospective observational cohort study conducted over a 21-year period at a single tertiary referral center. Methods In this retrospective cohort study, we analyzed 107 patients with benign airway tumors, specifically comparing 56 hamartomas and 51 leiomyomas. Data on clinical presentation, radiologic findings, and bronchoscopic intervention outcomes were collected. A stratified analysis by airway level (trachea to segmental bronchi) was performed. Results Endobronchial leiomyomas were predominantly located in the central airways (trachea, 29.4%), while endobronchial hamartomas were more frequent in peripheral bronchi (segmental, 35.7%; P for trend = 0.011). Peripheral tumors showed significantly higher degrees of stenosis ( P for trend < 0.001) and more frequent secondary CT findings, such as obstructive pneumonia. The complete resection rate was significantly higher for leiomyomas than for hamartomas (94.1% vs . 80.4%; P = 0.035). However, this difference was driven by anatomic location rather than histology; complete resection rates declined from 100% in the trachea to 64.5% in the segmental bronchi ( P for trend < 0.001). Major complications included three pneumothoraxes and one massive hemorrhage during distal airway dissection. No recurrences occurred during a median follow-up of 10 months. Conclusion Bronchoscopic resection is highly effective for benign airway tumors. Anatomic location, rather than histological subtype, is the primary determinant of procedural success and technical difficulty. Meticulous preoperative anatomical mapping is essential to identify danger zones near major vessels and optimize therapeutic strategies.