Exploring the carcinoid crisis: insights from a cancer-specific centre

Area of Science:

• Endocrinology
• Oncology
• Cardiology

Background:

• Carcinoid syndrome (CS) patients undergoing procedures are at risk of carcinoid crisis (CC).
• Understanding CC prevalence and risk factors is crucial for patient management.

Purpose of the Study:

• To determine the incidence, pre-procedure biomarkers, and management strategies for carcinoid crisis (CC) in a specialized cancer hospital.
• To identify factors associated with CC and its impact on patient outcomes.

Main Methods:

• Retrospective observational study of 48 patients with CS undergoing 71 procedures over 5 years.
• CC incidence assessed using strict (<80 mmHg SBP for >10 min) and broad criteria (severe hemodynamic instability).
• Electronic hemodynamic data and patient records were analyzed.

Main Results:

• CC occurred in 43% of procedures by broad criteria and 20% by strict criteria; no CC during systemic therapies.
• Strictly defined CC was associated with higher chromogranin A, 5-HIAA, BNP, longer hospital stay, and more postoperative complications.
• Lower intraoperative mean arterial pressure (MAP) correlated with worse postoperative outcomes and longer hospital stay.

Conclusions:

• Pre-operative biomarker assessment is vital for identifying CS patients at risk of CC.
• Intraoperative hypotension is a significant predictor of adverse postoperative outcomes and a key definition for CC in this cohort.