Surgical treatment of advanced-stage carcinoid tumors: lessons learned.
OBJECTIVE
To evaluate clinical outcomes in a large group of advanced-stage carcinoid patients (stage IV) following multimodal surgical therapy.


BACKGROUND
Patients with advanced-stage carcinoid have traditionally experienced poor 5-year survival (18%-30%). Few recent series have evaluated a large number of patients treated with aggressive surgical rescue therapy.


METHODS
This single-center retrospective review analyzes the records of 82 consecutive carcinoid patients treated by the same 2 surgeons, from August 1998 through August 2004 with a 3- to 72-month follow-up.


RESULTS
Surprisingly, one third of 26 (32%) patients were found to have intestinal obstructions; 10 being moribund at presentation. Mesenteric encasement with intestinal ischemia was successfully relieved in 10 of 12 cases. Five of eighty-two "terminal" patients were rendered free of macroscopic disease. Karnofsky performance scores improved from 65 to 85 (P < 0.0001). Two- and four-year survival for patients with no or unilateral liver metastases (n = 23) was 89%, while 2- and 4-year survival for patients with bilateral liver disease (n = 59) was 68% and 52% (P = 0.072), respectively.


CONCLUSIONS
We think that all patients with advanced-stage carcinoid should be evaluated for possible multimodal surgical therapy. Primary tumors should be resected, even in the presence of distant metastases to prevent future intestinal obstruction. The "wait and see" method of management of this slow-growing cancer no longer has merit. We offer an algorithm for the surgical evaluation and management of these patients.
Boudreaux
J Philip
JP
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. philip.boudreaux@tenethealth.com
Putty
Bradley
B
Frey
Daniel J
DJ
Woltering
Eugene
E
Anthony
Lowell
L
Daly
Ivonne
I
Ramcharan
Thiagarajan
T
Lopera
Jorge
J
Castaneda
Wilfrido
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D002276:Carcinoid Tumor / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000209:etiology; D008875:Middle Aged; D009367:Neoplasm Staging; D015282:Octreotide / Q000008:administration & dosage; D012189:Retrospective Studies
D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide