Surgical treatment of advanced-stage carcinoid tumors: Lessons learned

J. Philip Boudreaux, Bradley Putty, Daniel J. Frey, Eugene Woltering, Lowell Anthony, Ivonne Daly, Thiagarajan Ramcharan, Jorge E Lopera, Wilfrido Castaneda, Courtney M. Townsend, Leslie H. Blumgart, Robert C G Martin, Michael A. Choti

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)839-846
Number of pages8
JournalAnnals of Surgery
Volume241
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

Fingerprint

Carcinoid Tumor
Therapeutics
Intestinal Obstruction
Survival
Neoplasm Metastasis
Liver Diseases
Neoplasms
Ischemia
Liver

ASJC Scopus subject areas

  • Surgery

Cite this

Boudreaux, J. P., Putty, B., Frey, D. J., Woltering, E., Anthony, L., Daly, I., ... Choti, M. A. (2005). Surgical treatment of advanced-stage carcinoid tumors: Lessons learned. Annals of Surgery, 241(6), 839-846. https://doi.org/10.1097/01.sla.0000164073.08093.5d

Surgical treatment of advanced-stage carcinoid tumors : Lessons learned. / Boudreaux, J. Philip; Putty, Bradley; Frey, Daniel J.; Woltering, Eugene; Anthony, Lowell; Daly, Ivonne; Ramcharan, Thiagarajan; Lopera, Jorge E; Castaneda, Wilfrido; Townsend, Courtney M.; Blumgart, Leslie H.; Martin, Robert C G; Choti, Michael A.

In: Annals of Surgery, Vol. 241, No. 6, 06.2005, p. 839-846.

Research output: Contribution to journalArticle

Boudreaux, JP, Putty, B, Frey, DJ, Woltering, E, Anthony, L, Daly, I, Ramcharan, T, Lopera, JE, Castaneda, W, Townsend, CM, Blumgart, LH, Martin, RCG & Choti, MA 2005, 'Surgical treatment of advanced-stage carcinoid tumors: Lessons learned', Annals of Surgery, vol. 241, no. 6, pp. 839-846. https://doi.org/10.1097/01.sla.0000164073.08093.5d
Boudreaux JP, Putty B, Frey DJ, Woltering E, Anthony L, Daly I et al. Surgical treatment of advanced-stage carcinoid tumors: Lessons learned. Annals of Surgery. 2005 Jun;241(6):839-846. https://doi.org/10.1097/01.sla.0000164073.08093.5d
Boudreaux, J. Philip ; Putty, Bradley ; Frey, Daniel J. ; Woltering, Eugene ; Anthony, Lowell ; Daly, Ivonne ; Ramcharan, Thiagarajan ; Lopera, Jorge E ; Castaneda, Wilfrido ; Townsend, Courtney M. ; Blumgart, Leslie H. ; Martin, Robert C G ; Choti, Michael A. / Surgical treatment of advanced-stage carcinoid tumors : Lessons learned. In: Annals of Surgery. 2005 ; Vol. 241, No. 6. pp. 839-846.
@article{245650e09ab04c1d8ccc7950ca619ca9,
title = "Surgical treatment of advanced-stage carcinoid tumors: Lessons learned",
abstract = "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.",
author = "Boudreaux, {J. Philip} and Bradley Putty and Frey, {Daniel J.} and Eugene Woltering and Lowell Anthony and Ivonne Daly and Thiagarajan Ramcharan and Lopera, {Jorge E} and Wilfrido Castaneda and Townsend, {Courtney M.} and Blumgart, {Leslie H.} and Martin, {Robert C G} and Choti, {Michael A.}",
year = "2005",
month = "6",
doi = "10.1097/01.sla.0000164073.08093.5d",
language = "English (US)",
volume = "241",
pages = "839--846",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Surgical treatment of advanced-stage carcinoid tumors

T2 - Lessons learned

AU - Boudreaux, J. Philip

AU - Putty, Bradley

AU - Frey, Daniel J.

AU - Woltering, Eugene

AU - Anthony, Lowell

AU - Daly, Ivonne

AU - Ramcharan, Thiagarajan

AU - Lopera, Jorge E

AU - Castaneda, Wilfrido

AU - Townsend, Courtney M.

AU - Blumgart, Leslie H.

AU - Martin, Robert C G

AU - Choti, Michael A.

PY - 2005/6

Y1 - 2005/6

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=21144456384&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21144456384&partnerID=8YFLogxK

U2 - 10.1097/01.sla.0000164073.08093.5d

DO - 10.1097/01.sla.0000164073.08093.5d

M3 - Article

C2 - 15912033

AN - SCOPUS:21144456384

VL - 241

SP - 839

EP - 846

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -