OBJECTIVE: To evaluate clinical outcomes in a large group of advanced-stage carcinoid patients (stage IV) following multimodal surgical therapy. SUMMARY BACKGROUND DATA: 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. CONCLUSION: 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.
OBJECTIVE: To evaluate clinical outcomes in a large group of advanced-stage carcinoidpatients (stage IV) following multimodal surgical therapy. SUMMARY BACKGROUND DATA: 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 carcinoidpatients 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. CONCLUSION: 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.
Authors: K Oberg; L Kvols; M Caplin; G Delle Fave; W de Herder; G Rindi; P Ruszniewski; E A Woltering; B Wiedenmann Journal: Ann Oncol Date: 2004-06 Impact factor: 32.976
Authors: Seza A Gulec; Timothy S Mountcastle; Daniel Frey; Jason D Cundiff; Elizabeth Mathews; Lowell Anthony; J Patrick O'Leary; J Philip Boudreaux Journal: Am Surg Date: 2002-08 Impact factor: 0.688
Authors: R Sutton; H E Doran; E M I Williams; J Vora; S Vinjamuri; J Evans; F Campbell; M G T Raraty; P Ghaneh; M Hartley; G J Poston; J P Neoptolemos Journal: Endocr Relat Cancer Date: 2003-12 Impact factor: 5.678
Authors: Eugene A Woltering; James M Lewis; P Johnstone Maxwell; Daniel J Frey; Yi-Zarn Wang; John Rothermel; Catherine T Anthony; Douglas A Balster; J Patrick O'Leary; Lynn H Harrison Journal: Ann Surg Date: 2003-06 Impact factor: 12.969
Authors: William H Kitchens; Nahel Elias; Lawrence S Blaszkowsky; A Benedict Cosimi; Martin Hertl Journal: World J Surg Oncol Date: 2011-01-31 Impact factor: 2.754
Authors: Ashley Kieran Clift; Omar Faiz; Adil Al-Nahhas; Andreas Bockisch; Marc Olaf Liedke; Erik Schloericke; Harpreet Wasan; John Martin; Paul Ziprin; Krishna Moorthy; Andrea Frilling Journal: J Gastrointest Surg Date: 2015-09-22 Impact factor: 3.452
Authors: Eric H Liu; Carmen C Solorzano; Laurence Katznelson; Aaron I Vinik; Richard Wong; Gregory Randolph Journal: Endocr Pract Date: 2015-05 Impact factor: 3.443
Authors: Kendall J Keck; Jessica E Maxwell; Yusuf Menda; Andrew Bellizzi; Joseph Dillon; Thomas M O'Dorisio; James R Howe Journal: Surgery Date: 2016-11-15 Impact factor: 3.982
Authors: Chanjuan Shi; Raul S Gonzalez; Zhiguo Zhao; Tatsuki Koyama; Toby C Cornish; Kenneth R Hande; Ronald Walker; Martin Sandler; Jordan Berlin; Eric H Liu Journal: Am J Clin Pathol Date: 2015-03 Impact factor: 2.493