Diagnostic, surgical and medical aspect of the midgut carcinoids

This review covers the incidence, prognosis, diagnosis and treatment of midgut carcinoids with emphasis on the surgical and peri-operative aspects. Midgut carcinoids are rare neuro-endocrine tumours which become manifest once they have metastasized to the liver. Treatment of metastatic disease may include radical resection but is usually palliative. The tumour grows relatively slow. Besides the biochemical effects resulting in the carcinoid syndrome, patients may suffer from mechanical mass effects of the tumour. Medical treatment can alleviate the biochemical effects of the tumour, but has a limited effect on tumour growth. The introduction of octreotide was a milestone in palliation of these symptoms and has led to more aggressive treatment protocols. Treatment aimed at cytoreduction of hepatic metastasis and diminished secretion of bioactive amines may achieve good palliation. Cytoreduction may be performed by means of surgery, hepatic arterial ligation, (chemo)embolization, cryosurgery, radio-frequency ablation, internal radiation or even liver transplantation. The role of these options will be discussed in this review.