Continuous infusion of octreotide combined with perioperative octreotide bolus does not prevent intraoperative carcinoid crisis

Condron, Mary; Pommier, SuEllen J.; Pommier, Rodney F.

doi:10.1016/j.surg.2015.05.036

Cited by 71 publications

(72 citation statements)

References 18 publications

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“…13 All patients received a preoperative intravenous bolus of 500 mcg followed by a continuous infusion at 500 mcg/hr. However, the rate of events in this series was still 30%.…”

Section: Resultsmentioning

confidence: 99%

The Surgical Management of Small Bowel Neuroendocrine Tumors

Howe¹,

Cardona²,

Fraker³

et al. 2017

Pancreas

Self Cite

295

188

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Small bowel neuroendocrine tumors (SBNETs) have been increasing in frequency over the past decades, and are now the most common type of small bowel tumor. Consequently, general surgeons and surgical oncologists are seeing more patients with SBNETs in their practices than ever before. The management of these patients is often complex, owing to their secretion of hormones, frequent presentation with advanced disease, and difficulties with making the diagnosis of SBNETs. Despite these issues, even patients with advanced disease can have long-term survival. There are a number of scenarios which commonly arise in SBNET patients where it is difficult to determine the optimal management from the published data. To address these challenges for clinicians, a consensus conference was held assembling experts in the field to review and discuss the available literature and patterns of practice pertaining to specific management issues. This paper summarizes the important elements from these studies and the recommendations of the group for these questions regarding the management of SBNET patients.

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“…13 All patients received a preoperative intravenous bolus of 500 mcg followed by a continuous infusion at 500 mcg/hr. However, the rate of events in this series was still 30%.…”

Section: Resultsmentioning

confidence: 99%

The Surgical Management of Small Bowel Neuroendocrine Tumors

Howe¹,

Cardona²,

Fraker³

et al. 2017

Pancreas

Self Cite

295

188

View full text Add to dashboard Cite

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“…Hypotension occurring in the setting of carcinoid crisis may be managed with bolus intravenous doses of octreotide up to 1 mg until control of symptoms is achieved or with continuous intravenous infusion of octreotide at 50 to 200 μg per hour after the bolus dose . The role of prophylactic octreotide in the management of carcinoid crisis recently has been questioned, because rates of intraoperative complications were reported as similar in patients who did or did not receive preoperative octreotide bolus or continuous octreotide infusion . Nonetheless, ENETS guidelines recommend perioperative octreotide prophylaxis in patients with carcinoid syndrome …”

Section: Treatment Of Advanced Tumorsmentioning

confidence: 99%

“…118 The role of prophylactic octreotide in the management of carcinoid crisis recently has been questioned, because rates of intraoperative complications were reported as similar in patients who did or did not receive preoperative octreotide bolus or continuous octreotide infusion. 119,120 Nonetheless, ENETS guidelines recommend perioperative octreotide prophylaxis in patients with carcinoid syndrome. 121 Both octreotide and lanreotide are active at controlling hormonal symptoms associated with functioning pNETs.…”

Section: Somatostatin Analogsmentioning

confidence: 99%

Gastroenteropancreatic Neuroendocrine Tumors

Cives

Strosberg

2018

CA A Cancer J Clinicians

479

411

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Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from the diffuse neuroendocrine system. They frequently originate in the gastroenteropancreatic (GEP) tract and the bronchopulmonary tree, and their incidence has steadily increased in the last 3 decades. Fundamental biologic and genomic differences underlie the clinical heterogeneity of NETs, and distinct molecular features characterize NETs of different grades and different primary sites. Although surgery remains the cornerstone of treatment for localized tumors, systemic treatment options for patients with metastatic NETs have expanded considerably. Somatostatin analogs have demonstrated both antisecretory and antitumor efficacy. Peptide receptor radionuclide therapy with lutetium‐177 dotatate (177Lu‐DOTATATE) has been approved for advanced GEP‐NETs. The antitumor activity of everolimus has been demonstrated across a wide spectrum of NETs, and the antiangiogenic agent sunitinib has been approved for pancreatic NETs (pNETs). Chemotherapy with temozolomide and capecitabine has recently demonstrated an unprecedented prolongation of progression‐free survival in a randomized trial of pNETs. Multiple retrospective series have reported the efficacy of liver‐directed therapies both for palliating symptoms of hormone excess and for controlling tumor growth. Telotristat, an oral inhibitor of tryptophan hydroxylase, has been shown to reduce diarrhea in patients with carcinoid syndrome. Defining the therapeutic algorithm and identifying biomarkers predictive of response to treatments are among the main priorities for the next decade of research in the NET field.

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“…Patients with CS are at risk for developing a carcinoid crisis, characterised by excessive flushing, alterations in thermoregulation, bronchospasm and haemodynamic instability, mainly in the form of hypotension (Condron et al 2016). The crisis may occur following diagnostic or therapeutic procedures, induction of anaesthesia and/or as a result of tumour manipulation (Plöckinger et al 2004).…”

Section: Carcinoid Crisismentioning

confidence: 99%

“…Patients pre-treated with SSAs may require even higher doses and treatment should be continued at least 48 h after the end of the procedure, as late-onset events have been described (Ramage et al 2012). However, a recent analysis of 127 patients who underwent surgical procedures with concomitant continuous octreotide infusion demonstrated that a carcinoid crisis may still develop, particularly in patients with hepatic metastases and symptoms of CS, although neither was required for a crisis to occur (Condron et al 2016). Combination treatment with H1 and H2 receptor blockers may also be administered, along with glucocorticoids, since histamine release and its peripheral actions are not completely blocked by SS analogues (Kaltsas et al 2004, Plöckinger et al 2004 (Fig.…”

Section: Carcinoid Crisismentioning

confidence: 99%

Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours

Dimitriadis¹,

Weickert²,

Randeva³

et al. 2016

Endocrine-Related Cancer

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Although recent epidemiological evidence indicates that the prevalence of non-functioning gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) is rising, a significant number of GEP-NETs still present with symptoms related to the secretion of biologically active substances leading to the development of distinct clinical syndromes. In the past, these syndromes were associated with substantial morbidity and mortality due to the lack of specific therapies; however, since the introduction of long-acting somatostatin analogues and medications such as proton pump inhibitors, their control has been greatly improved. As a result, nowadays, the main cause of morbidity and mortality in GEP-NETs is mostly directly related to tumour growth and the extent of metastatic disease. However, in some patients with functioning tumours and extensive disease, control of the secretory syndrome still remains problematic, necessitating the employment of several cytoreductive techniques, which may not always be sufficient. Recently, new agents directed against tumour growth, or exerting increased binding activity to receptors expressed in these tumours, or interfering with the synthetic pathway of some of the compounds secreted by these tumours, have been developed. Since there are no specific guidelines addressing the totality of the management of the secretory syndromes related to GEP-NETs, this review aims at critically analysing the medical management of previously recognised secretory syndromes; it also addresses areas of uncertainty, assesses the newer therapeutic developments and also addresses recently described but poorly characterised secretory syndromes related to GEP-NETs.

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Continuous infusion of octreotide combined with perioperative octreotide bolus does not prevent intraoperative carcinoid crisis

Cited by 71 publications

References 18 publications

The Surgical Management of Small Bowel Neuroendocrine Tumors

The Surgical Management of Small Bowel Neuroendocrine Tumors

Gastroenteropancreatic Neuroendocrine Tumors

Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours

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