Influence of carcinoid syndrome on the clinical characteristics and outcomes of patients with gastroenteropancreatic neuroendocrine tumors undergoing operative resection

Kimbrough, Charles W.; Beal, Eliza W.; Dillhoff, Mary; Schmidt, Carl; Pawlik, Timothy M.; Lopez‐Aguiar, Alexandra G.; Poultsides, George A.; Makris, Eleftherios; Rocha, Flavio G.; Crown, Angelena; Abbott, Daniel E.; Fisher, Alan E.; Fields, Ryan C.; Krasnick, Bradley A.; Idrees, Kamran; Marincola-Smith, Paula; Cho, Clifford S.; Beems, Megan; Maithel, Shishir K.; Cloyd, Jordan M.

doi:10.1016/j.surg.2018.09.008

Cited by 17 publications

(10 citation statements)

References 24 publications

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“…Agreement: Round 1 -97%; Round 2 -97% Preoperative evaluation includes a thorough examination of history and physical findings, diagnostic workup, and a multidisciplinary tumor board discussion. [24][25][26] This includes a detailed assessment of functional symptoms, such as carcinoid syndrome and carcinoid heart disease. Additionally, we emphasize the early involvement for patient support groups, social work, genetic counseling, fertility specialists, psychosocial support, and programs dedicated to exercise and nutritional wellness for preoperative optimization.…”

Section: Block 1: Preoperative Considerationsmentioning

confidence: 99%

Consensus Guideline for the Management of Peritoneal Metastases in Patients with Neuroendocrine Neoplasms

Turaga

2024

Preprint

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Background Neuroendocrine neoplasms (NEN) with peritoneal metastases (PM) represent a complex clinical challenge due to low incidence and heterogeneous phenotypes. This manuscript describes the results of a national consensus aimed at addressing clinical management of patients with NEN-PMs. Methods An update of the 2018 Chicago consensus guidelines was conducted using a modified Delphi technique, encompassing two rounds of voting. The levels of agreement for various pathway blocks were rigorously assessed. Key systemic therapy concepts were summarized by content experts. Supporting evidence was evaluated via a rapid literature review. Results Overall, the level of evidence for the management of PM in this disease was universally low. In total, 107 participants responded in the first round, with 88/107 (82%) participating in the second round. Strong consensus (> 90%) was achieved in 5/7 (71%) and 7/7 (100%) blocks in rounds I and II respectively. A multidisciplinary approach including psychosocial and wellness assessments received a strong positive recommendation. Management of NENs with PMs was organized according to disease grade and symptom profiles. In grade 1 and 2 well-differentiated NENs, cytoreductive surgery (CRS) received strong support (>95%) following the management of functional syndromes (if present). For grade 3 well-differentiated NENs, systemic therapy is the primary recommendation, with surgical resection considered in select cases. Poorly differentiated NENs (i.e. neuroendocrine carcinomas) are predominantly treated with chemotherapy. Conclusion Given limited evidence, the consensus-driven clinical pathway offers vital clinical guidance for the management on NENs with PM. The need for high-quality evidence remains critical to the field.

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Section: Block 1: Preoperative Considerationsmentioning

confidence: 99%

Consensus Guideline for the Management of Peritoneal Metastases in Patients with Neuroendocrine Neoplasms

Turaga

2024

Preprint

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“…Nevertheless, several specific considerations should be undertaken for patients with NETs. Specifically, patients with NELM are at risk for carcinoid crisis (6). While some clinicians recommend the use of perioperative octreotide, the appropriate perioperative dosage as well as its actual efficacy remains a matter of debate (50).…”

Section: Perioperative Managementmentioning

confidence: 99%

“…Indeed, the presence of NELM is one of the most significant negative prognostic factors for long-term survival among patients with NETs (4). In addition, patients with liver metastases can experience debilitating carcinoid syndrome, as well as local complications such as biliary obstruction or liver insufficiency (5,6). For these reasons,…”

mentioning

confidence: 99%

Neuroendocrine liver metastases: a contemporary review of treatment strategies

Cloyd

Ejaz

Konda

et al. 2020

Hepatobiliary Surg Nutr

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patients developing neuroendocrine liver metastases (NELM) in their lifetime (1,2). NELM can be associated with significant detriments in quality and quantity of life (3). Indeed, the presence of NELM is one of the most significant negative prognostic factors for long-term survival among patients with NETs (4). In addition, patients with liver metastases can experience debilitating carcinoid syndrome, as well as local complications such as biliary obstruction or liver insufficiency (5,6). For these reasons,

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“…However, several specific considerations should be undertaken for patients with neuroendocrine tumors. First, patients with NELM are at risk for carcinoid crisis (49). While the incidence of carcinoid crisis is low, some clinicians recommend the use of perioperative octreotide given that the disadvantages and cost of administration are relatively low and the consequences of developing a carcinoid crisis potentially catastrophic.…”

Section: Perioperative Managementmentioning

confidence: 99%

Surgical management of pancreatic neuroendocrine liver metastases

Cloyd¹,

Wiseman²,

Pawlik³

2020

J Gastrointest Oncol

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Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of neoplasms that vary in their clinical presentation, behavior and prognosis. The most common site of metastasis is the liver. Surgical resection of neuroendocrine liver metastases (NELM) is thought to afford the best long-term outcomes when feasible. Initial preoperative workup should include surveillance for carcinoid syndrome, screening for evidence of liver insufficiency, and performance of imaging specific to neuroendocrine tumors such as a somatostatin receptor positron emission tomography scan. Standard surgical principles apply to hepatic surgery for NELM, namely prioritizing low central venous pressure anesthesia, minimizing blood loss, knowledge of liver anatomy, generous use of intraoperative ultrasound, as well as safe parenchymal transection techniques and practices to avoid bile leakage. Knowledge of established prognostic factors may assist with patient selection, which is important for optimizing short-and long-term outcomes of hepatic resection. Adjunct therapies such as concomitant liver ablation are used frequently and are generally safe when used appropriately. For patients with synchronous resectable NELM, resection of the primary either in a staged or combined fashion is recommended. Primary tumor resection in the setting of unresectable metastatic disease is more controversial, however generally recommended if morbidity is acceptable. For patients who are not surgical candidates, due to either patient performance status or burden of liver disease, several liver-directed therapies such as transarterial embolization, chemoembolization, and radioembolization are available to assist with locoregional control, extend progression-free survival (PFS), and improve symptoms of carcinoid syndrome. Multiple systemic therapy options exist for patients with metastatic PNET which are often prioritized for those patients with advanced or progressive disease. A systematic approach in a multi-disciplinary setting is likely to result in the best long-term outcomes for patients with pancreatic NELM. Ongoing research is needed to determine the optimal patient selection for hepatic surgery as well as the ideal treatment sequencing for those patients with NELM.

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Influence of carcinoid syndrome on the clinical characteristics and outcomes of patients with gastroenteropancreatic neuroendocrine tumors undergoing operative resection

Cited by 17 publications

References 24 publications

Consensus Guideline for the Management of Peritoneal Metastases in Patients with Neuroendocrine Neoplasms

Consensus Guideline for the Management of Peritoneal Metastases in Patients with Neuroendocrine Neoplasms

Neuroendocrine liver metastases: a contemporary review of treatment strategies

Surgical management of pancreatic neuroendocrine liver metastases

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