• Cytoreductive surgery in patients with advanced-stage carcinoid tumors.

• [Malignant carcinoid of the last ileal ansa. Report on 2 consecutive clinical cases]

• Minimally invasive transanal surgery for localized rectal carcinoid tumors.

• [Neuroendocrine tumors of the stomach. Surgery therapy and prognosis]

• Chemoembolization in the treatment of metastatic ileocolic carcinoid.

1
UI - 12206599
AU - Gulec SA; Mountcastle TS; Frey D; Cundiff JD; Mathews E; Anthony L;
TI - O'Leary JP; Boudreaux JP Cytoreductive surgery in patients with advanced-stage carcinoid tumors.
SO - Am Surg 2002 Aug;68(8):667-71; discussion 671-2
AD - Department of Surgery, Louisiana State University Health Sciences Center, New Orleans 70119, USA.
The role of aggressive surgical resections as well as criteria for resectability in patients with advanced carcinoid tumors is not clearly defined. Thirty patients (17 male and 13 female) who were previously diagnosed to have "unresectable carcinoid disease" were treated using a multimodality approach over a period of 2 years. Extensive liver involvement was present in 28 of 30 (93%) of the cases. Small bowel involvement was noted in 22 of 30 (73%), and peritoneal/retroperitoneal/mesenteric invasion was observed in 15 of 30 (50%) of the cases. Three patients had remote metastases (brain, bone, and eye). Twenty of 30 (66%) patients had carcinoid syndrome with severely disabling symptoms. Eight patients (26%) had small bowel obstruction. All patients underwent at least one surgical exploration/intervention. Radiofrequency ablation (RFA) of one or more liver lesions was performed as an adjunct in 22 of 30 (73%) patients. Six patients (20%) had a second surgical procedure. There were 11 complications in eight patients (27%) after the initial operation. Median hospital stay for patients who underwent RFA only, RFA/liver resection, and liver resection with abdominal tumor debulking were 2, 4, 8, and 16 days respectively. Twenty-five of 30 patients (83%) showed symptomatic improvement. Mean pre- and postoperative Karnofsky physical performance scores were 55 and 85 respectively (P < 0.02). Small bowel obstruction was due to adhesions in five patients. All patients with intestinal obstruction had complete relief of their symptoms postoperatively. 5-Hydroxyindolacetic acid levels decreased by 50 per cent in all patients with follow-up determinations available. Aggressive surgical exploration and tumor debulking could be performed with significantly improved symptomatic outcome and relatively minor complications. Longer follow-up is needed for assessment of effect on survival.

2
UI - 11941295
AU - Russo A; Buccianelli E; Aloise F; Veltroni A
TI - [Malignant carcinoid of the last ileal ansa. Report on 2 consecutive clinical cases]
SO - Minerva Chir 2002 Apr;57(2):203-11
AD - Area a Gestione Sperimentale della Valdinievole, Unita Operativa di Chirurgia Generale, ASL n. 3, Pistoia, Presidio Ospedaliero SS. Cosma e Damiano, Pescia (Pistoia), Italy.
Carcinoid tumors are very rare neoplasms, arising from enterochromaffin cells, classified in Apud system, exhibiting an intermediate malignancy, because of their long lasting clinical silence and low evolution to advanced stage. At the same time, these features unfortunately cause a high incidence of lymphatic and liver metastases, visible at first diagnostic approach, which are also determined by aspecific symptoms and signs, especially involving jejunal and ileal carcinoids, as the two cases described, and by very frequent absence, in current clinical practice, of pathognomonic carcinoid syndrome. Two carcinoids located into the distal ileal ansa, strictly adjacent to the ileocecal valve, are reported; the first tumor, accompanied by lymphonodal positivity, the second by a solitary hepatic metastasis, requiring segmentectomy of the liver, in addition to right hemicolectomy.

3
UI - 12077639
AU - Maeda K; Maruta M; Utsumi T; Sato H; Masumori K; Koide Y
TI - Minimally invasive transanal surgery for localized rectal carcinoid tumors.
SO - Tech Coloproctol 2002 Apr;6(1):33-6
AD - Department of Surgery, Fujita Health University, School of Medicine, 1-98, Deangakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan. kmaeda@fujita-hu.ac.jp
Local excision is often fully justified for rectal carcinoid tumors. However insufficient surgical field and difficult access to proximal tumors have been drawbacks in performing pre-existing local excision procedures. A novel local excisional technique called minimally invasive transanal surgery (MITAS) has been experimented for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder was used and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. Eight patients with carcinoid tumors in the rectum (4 tumors in the upper rectum) underwent MITAS. Median distance from anal verge to proximal tumor was 6.5 cm (range, 5-12 cm). The median diameter of the tumor was 9 mm. Median operative time was 18.5 minutes and blood loss was minimal. No analgesics were needed postoperatively, and there was no morbidity or mortality. Full-thickness excision of the rectum was accomplished and the tumors confined in the submucosa were demonstrated histologically to be with free surgical margins. No recurrences have been observed with a median follow-up period of 39 months. The technique facilitates total excisional biopsy for rectal carcinoid tumors and reduces operative time, blood loss and complications.

4
UI - 12063917
AU - Bektas H; Langer F; Piso P; Werner U; Musholt TJ; Lehner F; Becker T;
TI - Klempnauer J [Neuroendocrine tumors of the stomach. Surgery therapy and prognosis]
SO - Chirurg 2002 Apr;73(4):331-5
AD - Klinik fur Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl Neuberg-Strasse 1, 30625 Hannover. Bektas.Hueseyin@mh-hannover.de
Gastric carcinoid tumors are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like (ECL) cells of the stomach. A classification system distinguishing three types of gastric carcinoid tumors has been proposed: 1) tumors related to chronic atrophic gastritis, 2) tumors associated with Zollinger-Ellison syndrome, and 3) sporadic lesions. It is apparent that hypergastrinemia-associated gastric carcinoids show a rather benign biological behavior. Normo-gastrinemic sporadic lesions, on the other hand, require an aggressive surgical management. We report seven patients with gastric neuroendocrine tumors ("carcinoids"), who underwent surgical treatment in our department between 1988 and 2000. Surgical therapy included total gastrectomy with D2 lymphadenectomy in two cases with type I tumors and for one patient with type III tumor. One patient with a type II tumor was treated by distal subtotal gastrectomy and another by antrectomy. A local excision was performed on one patient with type I tumor. After a mean follow-up of 8 years, 5 of 7 patients are alive without recurrence.

5
UI - 12145671
AU - Diculescu M; Atanasiu C; Arbanas T; Croitoru A; Mihalcea A; Becheanu G;
TI - Costinean S; Gheorghe L; Capsa R Chemoembolization in the treatment of metastatic ileocolic carcinoid.
SO - Rom J Gastroenterol 2002 Jun;11(2):141-7
AD - Centre of Gastroenterology and Hepatology, Fundeni Clinical Institute, Sos. Fundeni no. 258, 72437 Bucharest, Romania.
Carcinoid tumours are enigmatic, slow growing malignancies, which occur most frequently (74%) in the gastrointestinal tract. Symptoms of the carcinoid syndrome (flushing and diarrhoea) are infrequent, occurring in approximately 10% of the patients with small bowel carcinoid. A 45-year-old patient with multiple liver metastases, diagnosed in 1994 with nonHodgkin's lymphoma after undergoing surgery for a distal ileal tumour, was referred to us by the Department of Haematology. At that moment the issue of a differential diagnosis with a carcinoid tumour arose, due to the long evolution and lack of evidence to support the initial diagnosis. The carcinoid syndrome was in fact present (the patient experiencing flush after small amounts of alcohol and emotions) and also we identified elevated values of 5HIAA. Reevaluation of the histologic sections of the ileal tumour as well as an ultrasound guided fine needle aspiration of an intrahepatic lesion confirmed the diagnosis of "carcinoid tumour". This conclusion lead to new therapeutic options for this patient. One of the main therapeutic options used in treating multiple liver metastases from a carcinoid tumour is chemoembolization and this case offered an excellent opportunity to present this therapy.

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