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

To assess the prevalence, pre-procedure biomarkers, and management of carcinoid crisis (CC) in a cancer-specific hospital.

Retrospective observational study of subjects with carcinoid syndrome (CS) undergoing invasive procedures or systemic therapies over 5 years.

Electronic haemodynamic parameters and patient records were extracted. CC incidence was assessed using strict (SBP <80 mmHg, >10 min) or broad criteria (severe hypotension, hypertension, arrhythmias, >1 min).

48 patients with CS underwent 71 procedures (35 invasive procedures, 36 systemic therapies). CC did not occur during systemic therapies. Prophylactic octreotide infusion was used in 63% of invasive procedures. CC occurred in 43% of procedures as defined by broad criteria and in 20% as defined by strict criteria. Compared to those without CC, patients with strictly defined CC had higher chromogranin A (P < 0.001), higher 5-HIAA (P = 0.03), higher BNP (P = 0.03), longer hospital stay (P < 0.001), and higher postoperative complications (P < 0.001). Lower intraoperative mean arterial pressure (MAP) correlated with postoperative complications (ρ = -0.55, P = 0.004) and longer hospital stay (ρ = -0.62, P = 0.001). All subjects with strictly defined CC were treated with more than one drug; however, there were five patients with broadly defined CC who did not require treatment for transient haemodynamic instability.

Pre-operative biomarker assessment is essential to triage CS patients at risk of CC and thereafter trigger a risk-based management pathway. Prolonged intraoperative hypotension correlated best with postoperative outcomes, and is a better definition for CC in our cohort.