title: Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients.
abstract: OBJECTIVE
  Surgery in carcinoid patients can provoke a carcinoid crisis, which can have serious sequelae, including death. Octreotide prophylaxis is recommended to prevent carcinoid crisis, however there are few reports of outcomes and no large series examining its efficacy. We hypothesized that a 500 µg prophylactic octreotide dose is sufficient to prevent carcinoid crisis.
  
  
  METHODS
  Records of carcinoid patients undergoing abdominal operations during years 2007-2011 were retrospectively reviewed. Octreotide use and intraoperative and postoperative outcomes were analyzed.
  
  
  RESULTS
  Ninety-seven intraabdominal operations performed by a single surgeon were reviewed. Ninety percent of patients received preoperative prophylactic octreotide. Fifty-six percent received at least one additional intraoperative dose. Twenty-three patients (24%) experienced an intraoperative complication. Intraoperative complications correlated with presence of hepatic metastases but not presence of carcinoid syndrome. Postoperative complications occurred in 60% of patients with intraoperative complications versus 31% of those with none (P = 0.01).
  
  
  CONCLUSIONS
  Significant intraoperative complications occur frequently in patients with hepatic metastases regardless of presence of carcinoid syndrome and despite octreotide LAR or single dose prophylactic octreotide. Occurrence of such events correlates strongly with postoperative complications. Randomized controlled trials are needed to determine whether the administration of prophylactic octreotide is beneficial.
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Massimino
authors.forename: Ola
authors.initials: O
authors.lastname: Harrskog
authors.forename: Suellen
authors.initials: S
authors.lastname: Pommier
authors.forename: Rodney
authors.initials: R
authors.lastname: Pommier
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000150:complications / Q000556:secondary / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D015999:Multivariate Analysis; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000556:secondary; D011322:Primary Prevention / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D018931:Antineoplastic Agents, Hormonal; D005765:Gastrointestinal Agents; D015282:Octreotide