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Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients
Author(s) -
Massimino Kristen,
Harrskog Ola,
Pommier SuEllen,
Pommier Rodney
Publication year - 2013
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23323
Subject(s) - octreotide , medicine , carcinoid syndrome , complication , surgery , carcinoid tumors , bolus (digestion) , somatostatin , gastroenterology
Background and Objectives Surgery in carcinoid patients can provoke a carcinoid crisis, which can have serious sequelae, including death. Octreotide prophylaxis is recommended to prevent carcinoid crisis, however there are few reports of outcomes and no large series examining its efficacy. We hypothesized that a 500 µg prophylactic octreotide dose is sufficient to prevent carcinoid crisis. Methods Records of carcinoid patients undergoing abdominal operations during years 2007–2011 were retrospectively reviewed. Octreotide use and intraoperative and postoperative outcomes were analyzed. Results Ninety‐seven intraabdominal operations performed by a single surgeon were reviewed. Ninety percent of patients received preoperative prophylactic octreotide. Fifty‐six percent received at least one additional intraoperative dose. Twenty‐three patients (24%) experienced an intraoperative complication. Intraoperative complications correlated with presence of hepatic metastases but not presence of carcinoid syndrome. Postoperative complications occurred in 60% of patients with intraoperative complications versus 31% of those with none ( P = 0.01). Conclusions Significant intraoperative complications occur frequently in patients with hepatic metastases regardless of presence of carcinoid syndrome and despite octreotide LAR or single dose prophylactic octreotide. Occurrence of such events correlates strongly with postoperative complications. Randomized controlled trials are needed to determine whether the administration of prophylactic octreotide is beneficial. J. Surg. Oncol. 2013;107:842–846. © 2013 Wiley Periodicals, Inc.