World Journal of Surgery

, Volume 14, Issue 3, pp 377–383

Surgical treatment of mid-gut carcinoid tumors

  • Charlie Makridis
  • Kjell Öberg
  • Claes Juhlin
  • Jonas Rastad
  • Henry Johansson
  • Lars Erik Lörelius
  • Göran Åkerström
International Association of Endocrine Surgeons—Manuscripts Presented at the 33rd World Congress of the International Society of Surgery

Abstract

Coincident with medical antitumor treatment of 138 patients suffering from mid-gut carcinoid tumors, 51 patients were subjected to surgery with the principal aims of removing primary tumors and debulking mesenteric or liver metastases. Sixteen patients had previously been operated with intestinal resection or, when the tumors had been considered inexcisable, with intestinal bypass or laparotomy alone. Apart from exhibiting symptoms related to the carcinoid syndrome, the majority (approximately 60%) of the 51 patients had generally intermittent, subileus-like abdominal pain and weight loss. In 18 patients, these symptoms were pronounced and associated with intestinal obstruction or severe malnutrition. Computed tomography and arteriography efficiently demonstrated mesenteric and liver metastases. At laparotomy, the primary intestinal tumors were small, mainly less than 1 cm in diameter, and they were multiple in 39% of the patients. Mesenteric metastases measuring up to 12 cm in diameter were present in 86% of the patients. These metastases were frequently associated with a pronounced mesenteric and retroperitoneal fibrosis causing fixation, angulation, and obstruction of the bowel as well as incipient intestinal gangrene in 8 patients. In all but 6 patients, the primary tumors could be removed by comparatively limited intestinal resections although bulky mesenteric metastases were often dissected from the mesenteric vessels. Liver metastases, found in 49% of the patients, were generally bilateral and multiple, and major hepatic metastases were resected in 6 patients. The results support a role for surgery also in the more compromised patients with mid-gut carcinoid tumors and that such intervention may be associated with considerable symptomatic relief and substantial periods of survival.

Résumé

Parmi 138 patients traités par chimiothérapie pour tumeurs carcinoïdes intestinales, 51 ont eu une résection de leur tumeur primitive ou une chirurgie de réduction des métastases mésentèriques ou hépatiques. Seize patients avaient déjà été opérés d'une résection intestinale ou, quand on avait considéré les tumeurs comme inextirpables, d'une dérivation intestinale ou d'une laparotomie exploratrice. Mis à part les symptômes en rapport avec le syndrome carcinoïde, la plupart (60%) des 51 patients se plaignaient en général d'une douleur abdominale intermittente semblable à celle de l'occlusion intestinale et une perte de poids. Chez 18 patients ces symptômes étaient aigus et associés à une occlusion intestinale ou à une malnutrition sévère. Tomodensitométrie et artériographie ont été employés pour mettre en évidence les métastases du mésentère et du foie. A la laparotomie, les tumeurs intestinales primitives étaient petites, avec en général moins d'un cm de diamètre, et il y en avait plusieurs chez 39% des patients. Des métastases du mésentère mesurant plus de 12 cm de diamètre étaient présentes chez 86% des patients. Ces métastases était souvent associées à une importante fibrose mésentérique et rétropéritonéale provoquant adhérences, angulation et occlusion de l'intestin et un début de gangrène intestinale chez 8 patients. Chez tous les patients sauf 6, nous avons pu enlever les tumeurs primitives avec une résection de l'intestin relativement limitée alors qu'il existait de grosses métastases du mésentère, souvent dissociables des vaisseaux mésentériques. Les métastases du foie, retrouvées chez 49% des patients, étaient en général bilatérales et multiples, et, chez 6 patients, réséquables. Nos résultats parlent en faveur de la chirurgie même chez les patients avec des tumeurs carcinoïdes de l'intestin, même évoluées, et confirment que cette intervention peut être associée à d'importantes améliorations symptomatiques et à des périodes de survie conséquentes.

Resumen

Coincidente con el tratamiento médico antitumoral de 138 pacientes con tumores carcinoides del intestino medio, 51 pacientes fueron sometidos a cirugía con el propósito principal de remover los tumores primarios y disminuir la masa tumoral de metástasis mesentéricas o hepáticas. Dieciseis pacientes habían sido operados previamente con realización de resección intestinal o, cuando el tumor fue considerado no resecable, derivación intestinal o sólo laparatomía. Además de los síntomas relacionados con el síndrome carcinoide, la mayoría (60%) de los 51 pacientes presentó dolor abdominal intermitente y pérdida de peso, en 18 casos estos síntomas fueron severos y aparecieron asociados con obstrucción intestinal o con malnutrición severa. La tomografía computadorizada y la arteriografía demonstraron bien las metástasis mesentéricas y hepáticas. En la laparotomía los tumores intestinales primarios aparecieron como de tamaño pequeño, la mayoría de menos de un centimetro de diámetro, y múltiples en 39% de los casos. Metástasis mesentéricas hasta de 12 cm de diámetro ocurrieron en 86% de los pacientes. Tales metástasis con frecuencia aparecieron asociadas con marcada fibrosis mesentérica y retroperitoneal, produciendo fijación, angulación, y obstructión del intestino, así como gangrena intestinal incipiente en ocho pacientes. En todos los pacientes, menos en 6, se pudo resecar los tumores primarios mediante resecciones intestinales relativamente limitadas, aunque tumores muy voluminosos tuvieron que ser disecados de los vasos mesentéricos. Las metástasis hepáticas, presentes en 49% de los pacientes, generalmente fueron bilaterales y múltiples; en 6 pacientes se efectuó la resección de metástasis hepáticas mayores. Los resultados dan apoyo a la conducta de tratamiento quirúrgico también para los pacientes más comprometidos con tumores carcinoides del intestino medio y demuestran que la intervención puede resultar en considerable mejoría sintomática y sustanciales períodos de supervivencia.

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Copyright information

© Société Internationale de Chirurgie 1990

Authors and Affiliations

  • Charlie Makridis
    • 1
  • Kjell Öberg
    • 1
  • Claes Juhlin
    • 1
  • Jonas Rastad
    • 1
  • Henry Johansson
    • 1
  • Lars Erik Lörelius
    • 1
  • Göran Åkerström
    • 1
  1. 1.Departments of Surgery, Internal Medicine, and Diagnostic RadiologyUniversity HospitalUppsalaSweden

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