Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)842-846
Number of pages5
JournalJournal of Surgical Oncology
Volume107
Issue number8
DOIs
StatePublished - Jun 2013

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Octreotide
Intraoperative Complications
Carcinoid Tumor
Neoplasm Metastasis
Liver
Randomized Controlled Trials

Keywords

  • anesthesia
  • carcinoid crisis
  • neuroendocrine tumor

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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title = "Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients",
abstract = "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.",
keywords = "anesthesia, carcinoid crisis, neuroendocrine tumor",
author = "Kristen Massimino and Ola Harrskog and Pommier, {Su Ellen Johnson} and Rodney Pommier",
year = "2013",
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language = "English (US)",
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pages = "842--846",
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T1 - Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients

AU - Massimino, Kristen

AU - Harrskog, Ola

AU - Pommier, Su Ellen Johnson

AU - Pommier, Rodney

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N2 - 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.

AB - 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.

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