What is the role of surgery in the treatment of carcinoid tumor?

Updated: Feb 12, 2019
  • Author: Cameron K Tebbi, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

If feasible, the treatment of choice is surgical excision. Surgical technique may vary according to the type or location of the tumor.

  • In most appendiceal tumors, simple appendectomy is sufficient for treatment. In intestinal carcinoids, block resection of the tumor with adjacent lymph nodes must be attempted. In the bronchial location, aggressive surgical resection, and not bronchoscopic removal, is recommended. [44, 43]

  • In localized tumors, surgical resection can result in cure, with 70-90% survival rate.

  • In rectal tumors, endoscopic resection in adults is sufficient for small tumors measuring less than 1 cm, for tumors limited to the mucosa, and in tumors resected with adequate margin at presentation. Nevertheless, resection does not guarantee prevention of metastasis at a later date. [92] In adults, surgical resection of the primary tumor is shown to provide survival advantage. [93]

  • When total resection is not possible, debulking may provide symptomatic relief.

  • For hepatic tumors, surgical ligation of the hepatic artery can potentially deprive blood supply to the tumor cells and cause necrosis while preserving most of the normal live cells. However, over time new blood vessels develop and restore circulation.

  • Intra-arterial infusion of chemotherapeutic agents with chemoembolization of the hepatic artery may also provide effective, albeit short term, relief of symptoms due to hepatic metastasis. If hepatic metastasis is present but resectable, surgical resection is preferred.

  • In selected cases, cryotherapy can be effective. Bronchoscopic cryotherapy has been successfully applied in treatment of isolated endoluminal carcinoid tumor in an adult patient. [94]

  • In patients with tumors less than 1 cm located in the appendix, appendectomy is the treatment of choice. More extensive surgery is indicated for tumors larger than 2 cm, lymphatic invasion, lymph node involvement, mesoappendix infiltration, positive resection margins, and cellular pleomorphism with a high mitotic index. For tumors larger than 2 cm, accepted treatment has been hemicolectomy; however, a survival advantage over simple appendectomy has not been demonstrated. [95] Given the relatively low malignant potential of appendiceal carcinoids, some have suggested simple appendectomy for tumors more than 2 cm diameter without affecting overall survival. [96]


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