Surgical treatment of carcinoid tumours

Carcinoid tumours are the most common endocrine tumour of the gut comprising 75% of appendicular tumours and a third of ileal tumours. They are also an incidental finding in 1% of post mortems. Carcinoid syndrome however is rare and it is estimated that two cases would appear in a quarter of a million population over a decade. We have reviewed a consecutive series of carcinoid tumours accrued from 1976-1999 in order to further study the natural history of the disease and also to examine the relationship between pathological tumour size, extent of disease and prognosis for each tumour site. In this 19 year period 145 patients were treated for the disorder. The bronchus was the commonest site (35.9%) with appendix (24.8%) and ileal (13.8%) carcinoids comprising the majority of known primaries. Overall midgut carcinoids comprised 40.7% of the series with the carcinoid syndrome present in 20.3%. A significant group was constituted by those patients presenting with metastatic disease and an uncertain site of primary tumour (9.7%). Metastatic disease was not found on presentation or follow up in any patient with a foregut primary tumour less than 2 cm diameter or a midgut primary tumour less than 1 cm diameter; a direct correlation of size and metastases being found above these levels. Overall survival for all groups was 60% at 5 years with the best prognosis being seen in patients with bronchial or appendicular carcinoids. Other clinical features, pathology, extent of disease and prognosis of carcinoid tumour will be discussed along with the role of current management strategies.