Surgical management of carcinoid tumors: role of debulking and surgery for patients with advanced disease.

Surgery is the only potentially curative treatment for patients with carcinoid tumors. Patients with localized disease even with lymph node metastases can be resected for potential cure. Patients with distant metastatic disease have been reported to be cured by resection of all tumor. However, long-term follow-up of these individuals suggests that these patients probably will recur. Debulking surgery, that is removal of part but not all disease, has been advocated by some to decrease symptoms secondary to hormone secretion, relieve intestinal obstruction and ischemia, and prolong survival. Certainly, the first and second indications have been demonstrated by retrospective analysis of patient records. The final indication is less substantiated. It is my opinion that surgery to prolong survival will be beneficial if all gross tumor can be removed. Debulking procedures may improve quality but not quantity of life. Because of the potential benefits of surgery in the management of all patients with carcinoid tumors, a surgeon should be part of the team of physicians who manage these complex patients.