Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2016) 46 P14 | DOI: 10.1530/endoabs.46.P14

UKINETS2016 Poster Presentations (1) (35 abstracts)

Perioperative carcinoid crisis during surgery-who benefits from octreotide?

Khalil ElGendy 1, , Sarah Johnnson 1, , Jeremy French 1, , Steven White 1, , Richard Charnley 1, , Derek Manas 1, & Colin Wilson 1,

1NET Service, Newcastle-upon-Tyne Hospitals Trust, Newcastle-upon-Tyne, UK; 2Hepato-pancreatico-biliary Surgery, The Freeman Hospital, Newcastle-upon-Tyne, UK; 3Histopathology service, RVI, Newcastle-upon-Tyne, UK.

Introduction: Carcinoid crisis, as an entity is poorly defined, but can be seen in patients with small bowel NET tumours after open bowel surgery or tumour unrelated procedures as cardiovascular instability (CI). Recent evidence suggests that cardiovascular instability (CI) during NET surgery is more common than previously considered.

Aims and methods: We audited the incidence of CI during procedures and determined the relationship to perioperative octreotide; considering the patient’s underlying disease burden. Patients were identified from the hospital pathology database having had their primary tumour resected in our institution between January 2011 and December 2015. Our prophylactic octreotide protocol is an intravenous infusion of 50 micrograms an hour for 24 hours prior to surgery.

Results: About 54 patients underwent 65 procedures. About 24% (n=13) had carcinoid symptoms or syndrome prior to surgery. There was no postoperative mortality or direct morbidity related to CI in the 65 procedures. About 77% of patients had preoperative octreotide for at least 4 hours. Most procedures (67%) were complicated by CI not related to blood loss (Table 1). About 31 detailed anaesthetic charts were available for review.

Table 1 Presence of CI in relation to Octreotide therapy.
Cardiovascular Instability(Oct vs. No Oct)Chi χ2
Bowel resection, no liver mets (n=13)45.5% vs 50%P=0.9
Bowel resection, liver mets (n=9)50% vs 100%P=0.35
Simultaneous liver/bowel resection (n=9)87.5% vs 100%P=0.6

Conclusions: Octreotide infusion does reduce the incidence and severity of cardiovascular instability during surgery- but is not universal. Almost all patients undergoing bowel or liver resection in the presence of liver metastases will have some form of cardiovascular instability during the procedure. The postoperative effects are not directly discernible.

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