Effect of Surgery on the Outcome of Midgut Carcinoid Disease with Lymph Node and Liver Metastases

Department of Surgery, University Hospital, SE-751 85 Uppsala, Sweden.
World Journal of Surgery (Impact Factor: 2.64). 08/2002; 26(8):991-7. DOI: 10.1007/s00268-002-6630-z
Source: PubMed


We have evaluated survival and tumor-related symptoms in the presence of mesenteric lymph node and liver metastases in relation to surgical procedures in 314 patients (148 women, mean age at diagnosis 61 years; 249 with liver metastases) treated for midgut carcinoid tumors. Of the operated patients, 46% presented with severe abdominal pain and intestinal obstruction and were operated on before the diagnosis. Medical treatment (somatostatin analogs, interferon-a) was initiated in 67% and 86%, respectively. Surgical attempts included small intestine or ileocecal/right-sided colon resection with excision of mesenteric lymph node metastases. Most of the patients (n = 286) had mesenteric lymph node metastases; 33% of them had unresectable mesenteric lymph node metastases and underwent surgery without mesenteric dissection. Patients who underwent resection for the primary tumor had a longer survival than those with no resection (median survival 7.4 vs. 4.0 years; p <0.01). Patients who underwent successful excision of mesenteric metastases had a significantly longer survival than those with remaining lymph node metastases. Patients operated on for a primary tumor but with remaining lymph nodes but no liver metastases and who subsequently received interferon and somatostatin analog treatment had a median survival of 7.4 years. Resection of the primary tumor and the mesenteric lymph node metastases led to a significant reduction in tumor-related symptoms. Surgery to remove the primary intestinal tumor including mesenteric lymph node metastases is supported by the present results, even in the presence of liver metastases. Liver metastases and significant preoperative weight loss are identified as major negative prognostic factors for survival.

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Available from: Per Hellman, Sep 23, 2014
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    • "Furthermore, there was improved survival for patients who presented with stage 4 disease who had resection of primary tumour compared to those in whom the primary was not resected. Previous studies have demonstrated a survival benefit in resection of primary tumour; however, the study population has been rather heterogenous [29]. A recent systematic review by Capurso et al. [17] concluded that there is a possible benefit of resection of the primary lesion in patients with unresectable liver metastases. "
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    • "The presence of liver metastases is a distinguishing feature of malignant neuroendocrine tumors and is the rate-limiting step on patient's survival [101, 102]. Based on available data (Tables 1 and 2), we advocate an aggressive surgical policy and propose an evidence-based surgical management algorithm (Figure 1). "
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