Carcinoid syndrome surgery: Difference between revisions
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*'''Type II gastric carcinoids'''- because of their generally benign course similar to type I tumors, type II tumors can usually be managed with endoscopic resection (particularly for tumors <1 cm) followed by close endoscopic surveillance. Liberal surgical excision or gastric resection with regional lymphadenectomy is performed for larger and multifocal tumors or for those with deep wall invasion or angioinvasion.In patients with multiple tumors, somatostatin analog treatment may be used to reduce tumor growth, particularly if hypergastrinemia has not been reversed by surgery. | *'''Type II gastric carcinoids'''- because of their generally benign course similar to type I tumors, type II tumors can usually be managed with endoscopic resection (particularly for tumors <1 cm) followed by close endoscopic surveillance. Liberal surgical excision or gastric resection with regional lymphadenectomy is performed for larger and multifocal tumors or for those with deep wall invasion or angioinvasion.In patients with multiple tumors, somatostatin analog treatment may be used to reduce tumor growth, particularly if hypergastrinemia has not been reversed by surgery. | ||
*'''Type III gastric carcinoids'''- behave more aggressively than type I and type II tumors, are treated with gastric resection and regional lymphadenectomy. Tumors larger than 2 cm or those with atypical histology or gastric wall invasion are most appropriately dealt with by gastrectomy or radical gastrectomy. Most of these tumors are metastatic at the time of presentation. The 5-year survival may approach 50%, but, in patients with distant metastases, it is only 10%. | *'''Type III gastric carcinoids'''- behave more aggressively than type I and type II tumors, are treated with gastric resection and regional lymphadenectomy. Tumors larger than 2 cm or those with atypical histology or gastric wall invasion are most appropriately dealt with by gastrectomy or radical gastrectomy. Most of these tumors are metastatic at the time of presentation. The 5-year survival may approach 50%, but, in patients with distant metastases, it is only 10%. | ||
===Duodenal Carcinoids=== | |||
In general, endoscopic excision of primary duodenal carcinoids appears to be most appropriate for tumors smaller than 1 cm. Duodenal carcinoids smaller than 2 cm may be excised locally; for tumors between 1 cm and 2 cm, complete resection is ensured by operative full-thickness excision. Follow-up endoscopy is indicated. Tumors larger than 1 cm may be difficult to remove completely endoscopically and should be evaluated with endoscopic ultrasonography before endoscopic resection is attempted because of their potential to invade beyond the submucosa. | |||
==References== | ==References== | ||
Revision as of 15:03, 22 September 2015
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Carcinoid syndrome Microchapters |
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Carcinoid syndrome surgery On the Web |
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American Roentgen Ray Society Images of Carcinoid syndrome surgery |
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Risk calculators and risk factors for Carcinoid syndrome surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
For qualifying candidates, surgical resection of tumor and chemotherapy (5-FU and doxorubicin) can improve outcomes.
Surgery
Surgery, if feasible, is the only curative therapy. If the tumour has metastasized (most commonly, to the liver), the tumour may be ineligible for surgery (unresectable), though there are many promising treatment modalities, such as radiolabeled octreotide, that are very effective in arresting the growth of the tumours and prolonging survival in patients with liver metastases.
Gastric Carcinoids
- Type I gastric carcinoids- smaller than 1 cm are indolent with minimal risk for invasion and can be removed with endoscopic mucosal resection. Local surgical excision may be performed for rare larger or invasive tumors, but exceptional cases with large multifocal lesions may require gastric resection.
- Type II gastric carcinoids- because of their generally benign course similar to type I tumors, type II tumors can usually be managed with endoscopic resection (particularly for tumors <1 cm) followed by close endoscopic surveillance. Liberal surgical excision or gastric resection with regional lymphadenectomy is performed for larger and multifocal tumors or for those with deep wall invasion or angioinvasion.In patients with multiple tumors, somatostatin analog treatment may be used to reduce tumor growth, particularly if hypergastrinemia has not been reversed by surgery.
- Type III gastric carcinoids- behave more aggressively than type I and type II tumors, are treated with gastric resection and regional lymphadenectomy. Tumors larger than 2 cm or those with atypical histology or gastric wall invasion are most appropriately dealt with by gastrectomy or radical gastrectomy. Most of these tumors are metastatic at the time of presentation. The 5-year survival may approach 50%, but, in patients with distant metastases, it is only 10%.
Duodenal Carcinoids
In general, endoscopic excision of primary duodenal carcinoids appears to be most appropriate for tumors smaller than 1 cm. Duodenal carcinoids smaller than 2 cm may be excised locally; for tumors between 1 cm and 2 cm, complete resection is ensured by operative full-thickness excision. Follow-up endoscopy is indicated. Tumors larger than 1 cm may be difficult to remove completely endoscopically and should be evaluated with endoscopic ultrasonography before endoscopic resection is attempted because of their potential to invade beyond the submucosa.