title: The role of surgery in patients with advanced midgut carcinoid tumours.
abstract: 64 consecutive patients with disseminated midgut carcinoids were treated over 8 years by active intervention. Their 5-year survival was 57.5%. 14(22%) attained anatomical and biochemical cure by surgery alone. Their mean 5-hydroxindoleacetic acid (5-HIAA) levels were still normal after 69 +/- 6.2 months of follow-up. Subclinical disease was diagnosed in 7/14 patients using somatostatin receptor scintigraphy; subsequent re-exploration of 6 led to scintigraphically proven cure in 5.40 patients with bilobar hepatic disease underwent embolisation in combination with octreotide; their 5-HIAA levels were still reduced by 55% after 71 +/- 10 months of follow-up and their estimated 5-year survival was 56%. More specifically, those with good radiological response on computerised tomography (> 50%) had a pronounced reduction of 5-HIAA levels (81%) and low mortality, while those with poor radiological volume reduction had a limited reduction of 5-HIAA levels (28%) and a much higher mortality (death by tumour or cardiovascular disease). 10 patients were not embolised due to complicating diseases and had a very poor 5-year survival. The increased risk of cardiovascular death underlines the importance of total survival analysis in patients suffering from a disease with multiple hormonal effects.
authors.affiliation: Department of Surgery, Sahlgrenska Hospital, Göteborg, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Ahlman
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D018931:Antineoplastic Agents, Hormonal; D006897:Hydroxyindoleacetic Acid; D015282:Octreotide