SURGICAL OPTIONS
Complete removal of the tumour and surrounding tissue.
Involves the removal of a large portion of the tumour or cancerous cells to potentially increase the effectiveness of chemotherapy or radiation therapy that will follow. Cytoreductive procedures are also called debulking surgery.
Surgical procedures that are aimed at controlling symptoms caused by a tumour when maintaining quality of life is the primary goal.
EVIDENCE FOR SURGICAL OPTIONS
Surgical approaches:
- Canadian National Carcinoid Expert Group guidelines recommend
- consider surgery for cure, maximal debulking, or symptom palliation
- cytoreductive surgery at earliest opportunity
- short-acting octreotide should be given before surgery
- Consensus recommendations for management of neuroendocrine tumors of gastroenteropancreatic system
- surgical resection may have any of the following goals
- curative intent for primary and regional lesions
- palliative intent for primary and regional lesions
- cytoreductive intent for regional or distant metastatic disease
- cytoreductive surgery may include
- tumor resection
- radiofrequency ablation
- cryotherapy
- cholecystectomy
- recommended in patients having surgical abdominal exploration
- rationale to prevent cholelithiasis which is common side effect of somatostatin analog
- surgical resection may have any of the following goals
- no randomized trials identified to evaluate palliative cytoreductive surgery in nonresectable liver metastases from gastroenteropancreatic neuroendocrine tumors
- no trials identified evaluating liver resection for resectable liver metastases from gastroenteropancreatic neuroendocrine tumors
- cytoreductive hepatic resection for functioning metastatic neuroendocrine tumors reported to be safe and effective in selected patients
- Reference – Cancer Control 2002 Jan-Feb;9(1):67 full-text
- rectal tumors < 1 cm successfully treated with excision
- appendectomy is adequate therapy for incidental appendiceal carcinoids
- Reference – Arch Surg 2006 Apr;141(4):349 full-text
- Cardiac surgery: valve replacement may increase survival in patients with carcinoid heart disease
- Reference – Circulation 2005 Nov 22;112(21):3320 full-text
SURGICAL OPTIONS RESOURCES
Dr. Calvin Law
Dr. Calvin Law
VIDEOS ON SURGICAL PROCEDURES
Here you will find a collection of patient and family specific 3D computer animations that explain common liver, pancreas and transplant surgeries performed at Toronto General Hospital. These animations describe the general steps in the procedure, the risks and complications of the surgery, as well as post-operative care and discharge information.