World Journal of Surgery

, Volume 26, Issue 8, pp 991–997

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

Authors

  • Per Hellman
    • Department of Surgery, University Hospital, SE-751 85 Uppsala, Sweden
  • Tobias Lundström
    • Department of Surgery, University Hospital, SE-751 85 Uppsala, Sweden
  • Ulf Öhrvall
    • Department of Surgery, Södersjukhuset, Ringvägen 52, S-11883 Stockholm, Sweden
  • Barbro Eriksson
    • Department of Medicine, University Hospital, SE-751 85 Uppsala, Sweden
  • Britt Skogseid
    • Department of Medicine, University Hospital, SE-751 85 Uppsala, Sweden
  • Kjell Öberg
    • Department of Medicine, University Hospital, SE-751 85 Uppsala, Sweden
  • Eva Tiensuu Janson
    • Department of Medicine, University Hospital, SE-751 85 Uppsala, Sweden
  • Göran Åkerström
    • Department of Surgery, University Hospital, SE-751 85 Uppsala, Sweden

DOI: 10.1007/s00268-002-6630-z

Cite this article as:
Hellman, P., Lundström, T., Öhrvall, U. et al. World J Surg (2002) 26: 991. doi:10.1007/s00268-002-6630-z

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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Copyright information

© 2002 by the Société Internationale de Chiru rgie