Surgical Aspects of Carcinoid Tumours

Galland, R. B.

doi:10.1016/b978-0-7506-1390-3.50046-5

Cited by 2 publications

(1 citation statement)

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“…Very active surgery has become accepted as the treatment of choice for neuroendocrine tumours, many of which have a relatively slow growth (Galland and Blumgart, 1986;McEntee et al, 1990;Norton, 1994;Dousset et al, 1996). The active treatment of patients with advanced midgut carcinoids, including ischaemic tumour reduction of liver metastases, has resulted in long-term palliation of hormonal symptoms and high 5-year survival rates (Wängberg et al, 1996).…”

Section: mentioning

confidence: 99%

Comparison of survival between malignant neuroendocrine tumours of midgut and pancreatic origin

et al. 1999

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Neuroendocrine tumours of the gastrointestinal tract are rare diseases and with the presence of metastases, patients may suffer from disabling symptoms of hormone overproduction. Potentially curative surgery can be performed in patients with localized disease, and sometimes in patients with liver metastases. However, long-term follow-up of the latter patients mostly shows late tumour recurrences (Norton, 1994). Debulking (cytoreductive) surgery can be considered when most of the tumour burden can be excised safely to minimize hormonal symptoms and to facilitate medical therapy (McEntee et al, 1990;Carty et al, 1992;Que et al, 1995). An important question is whether the aggressive treatment of metastatic disease prolongs survival. No randomized studies are available today. Such studies are complicated by the lack of strict surgical treatment protocols running over long periods, the relatively low number of patients and the absence of a TNM (tumour, node, metastases) classification of these tumour types. Many clinical studies, in which debulking surgery and resection rates are discussed, are composed of patients with carcinoids and those with endocrine pancreatic tumours (EPT). However, these two disease entities may include tumours with markedly different biology.In our consecutive series of patients with advanced midgut carcinoids (all with locoregional and hepatic metastases) the estimated overall 5-year survival was 69% after active interventional treatment. The 5-year survival of carcinoid patients with bilobar liver metastases was 63% (cf. Wängberg et al, 1996). These figures are superior to the ones obtained after more conservative treatment. In a consecutive series of 42 patients with metastatic EPT from National Institutes of Health, the 5-year survival of those 17 patients resected for cure was 79% versus 28% in the non-resected group (Carty et al, 1992). Similar results were recently reported from the Mayo Clinic in 74 patients with hepatic metastases from either EPT or carcinoid tumours. The 4-year survival was 85% for one-third of the patients selected for resection versus 65% for the two-thirds non-resected (Que et al, 1995). In a recent French series of 34 patients with neuroendocrine tumours (carcinoids and EPT) and hepatic metastases, the liver resection rate was as high as 50%. Twelve of these 17 patients were operated upon with curative intent (Dousset et al, 1996).The aim of this retrospective study was to compare survival in our consecutive series of patients with malignant EPT with that of patients with advanced midgut carcinoids when subjected to similar treatment principles. Furthermore, EPT were staged according to the TNM classification of pancreatic carcinoma. By doing so, stage IV tumours should be compared with advanced carcinoid tumours with liver metastases.  Patients and treatmentThe 64 consecutive patients with advanced midgut carcinoids were treated during 1987-1997 (cf. Wängberg et al, 1996. All patients underwent primary surgery, removal of the primary tumo...

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Section: mentioning

confidence: 99%