Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours †

Abstract

Patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult patients from 1983 to 1996 who underwent abdominal surgery for metastatic carcinoid tumours. Preoperative risk factors, intraoperative complications and complications occurring in the 30 days after surgery were recorded. Perioperative complications or death occurred in 15 of 119 patients (12.6%, exact confidence interval 7.2-19.9). None of the 45 patients who received octreotide intraoperatively experienced intraoperative complications compared with eight of the 73 patients (11.0%) who did not receive octreotide (P=0.023). The presence of carcinoid heart disease and high urinary output of 5-hydroxyindoleacetic acid preoperatively were statistically significant risk factors for perioperative complications.

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors

“…Acute intravenous administration of octreotide has been reported to provide rapid reversal of carcinoid crisis, and current focus of carcinoid crisis therapy is to prevent mediator release with octreotide prophylaxis [1, 2, 6, 7, 14,18,19,20]. This has largely replaced use of other drugs for acute treatment.…”

Carcinoid Crisis in a Patient without Previous Carcinoid Syndrome: Perioperative Management and Anesthetics Considerations - A Case Report

“…For example Kinney et al [10] performed a retrospectively study in a group of patients who were submitted to abdominal surgery for metastatic carcinoid tumors. They found an incidence of intraoperative complication of 11% among patients who did not receive intraoperative octreotide and of 0% among those who received at least one dose.…”

Somatostatin Analogues Do Not Prevent Carcinoid Crisis

“…Massimino et al found octreotide LAR and bolus octreotide were insufficient for preventing intraoperative carcinoid crisis in carcinoid patients while Kinney et al reported differently. (Kinney et al, 2001;Massimino et al, 2013) The overall pooled risk showed perioperative carcinoid crisis was similar despite the prophylactic administration of SSTA (OR 0.44, 95% CI: 0.14 to 1.35, p=0.15) (Figure 2). …”