Intraoperative carcinoid syndrome during small-bowel neuroendocrine tumour surgery

Author:

Fouché Myrtille1,Bouffard Yves1,Le Goff Mary-Charlotte1,Prothet Johanne1,Malavieille François1,Sagnard Pierre1,Christin Françoise1,Hayi-Slayman Davy1,Pasquer Arnaud2,Poncet Gilles2,Walter Thomas3,Rimmelé Thomas14

Affiliation:

1. 1Department of Anaesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

2. 2Department of Visceral Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

3. 3Department of Hepatogastroenterology and Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

4. 4EA 7426 Hospices Civils de Lyon-University Claude Bernard Lyon 1-Biomérieux ‘Pathophysiology of Injury-Induced Immunosuppression’ Pi3, Lyon, France

Abstract

Only few descriptions of intraoperative carcinoid syndrome (ioCS) have been reported. The primary objective of this study was to describe ioCS. A second aim was to identify risk factors of ioCS. We retrospectively analysed patients operated for small-bowel neuroendocrine tumour in our institution between 2007 and 2015, and receiving our preventive local regimen of octreotide continuous administration. ioCS was defined as highly probable in case of rapid (<5 min) arterial blood pressure changes ≥40%, not explained by surgical/anaesthetic management and regressive ≥20% after octreotide bolus injection. Probable cases were ioCS which did not meet all criteria of highly-probable ioCS. Suspected ioCS were detected on the anaesthesia record by an injection of octreotide due to a manifestation which did not meet the criteria for highly-probable or probable ioCS. A total of 81 patients (liver metastases: 59, prior carcinoid syndrome: 49, carcinoid heart disease: 7) were included; 139 ioCS occurred in 45 patients: 45 highly probable, 67 probable and 27 suspected. ioCs was hypertensive (91%) and/or hypotensive (29%). There was no factor, including the use of vasopressors, significantly associated with the occurrence of an ioCS. All surgeries were completed and one patient died from cardiac failure 4 days after surgery. After preoperative octreotide continuous infusion, ioCS were mainly hypertensive. No ioCS risk factors, including vasopressor use, were identified. No intraoperative carcinoid crisis occurred, suggesting the clinical relevance of a standardized octreotide prophylaxis protocol.

Publisher

Bioscientifica

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine

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1. Carcinoid crisis: The challenge is still there;Endocrinología, Diabetes y Nutrición;2024-06

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3. Le cœur carcinoïde : physiopathologie, diagnostic, pronostic et prise en charge;Archives des Maladies du Coeur et des Vaisseaux - Pratique;2023-12

4. Management of Small Bowel Neuroendocrine Tumours: 10 Years’ Experience at a Tertiary Referral Centre;Cancers;2023-09-06

5. Carcinoid heart disease in patients with midgut neuroendocrine tumours;Journal of Neuroendocrinology;2023-04

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