Gastrointestinal carcinoids: Extrahepatic metastases and symptomatology following resection

Abstract

Of 49 patients with midgut and hindgut carcinoids, second primary distinct carcinomas occurred in 12. The most aggressive carcinoids were the 24 that arose in the distal small bowel and cecum. Of the patients affected, 15 had lymph node metastases and eight had liver metastases at the time of diagnosis. That only five patients were completely relieved of symptoms following resection was partially explained by autopsy findings in 15 patients, six of whom had metastatic extra-abdominal carcinoid without liver metastases (most commonly, bone metastases).

Progression of Metastases and Symptom Improvement from Laparotomy in Midgut Carcinoid Tumors

“…The presence of a carcinoid syndrome generally implies that the patient has liver metastases [1,3,[5][6][7][8][9], although symptoms also occur at advanced disease stages owing to mesenteric metastases and fibrosis, which may cause obstruction and ischemia of the intestine [1, 5, 9 -14]. Surgery is undertaken in patients with midgut carcinoids to remove the primary tumor, but it is also frequently required to alleviate symptoms related to the mesenteric involvement [4,5,[7][8][9][15][16][17][18][19][20][21][22]. A few patients are subjected to liver surgery, but this step seems to palliate the carcinoid syndrome only when unusually large and essentially solitary liver metastases are excised [3, 7-9, 16, 18, 21-31].…”