International expert consensus on perioperative management of carcinoid crisis

Carcinoid crisis is a critical concern for patients with neuroendocrine tumours undergoing invasive procedures. Guidance is needed to standardize and optimize perioperative care for patients at risk of carcinoid crisis. Consensus-based expert recommendations were developed for the perioperative management of carcinoid crisis among patients with midgut and bronchopulmonary neuroendocrine tumours undergoing non-cardiac surgery.

A modified Delphi approach was used with four rounds of voting to reach expert consensus on statements about perioperative management of carcinoid crisis. A multidisciplinary international panel of 44 experts was formed, and 3 patient partners were engaged. Statements addressing preoperative, intraoperative, and postoperative considerations were created. Panellists rated statements on a Likert scale (from 1 to 7). Three additional rounds of iterative rating and feedback were completed anonymously. Consensus was defined with median score between 5 and 7, and ≤ 13 panellists rating outside the score category containing the median.

Final consensus was reached on 41 statements. Of these, 12 focused on preoperative work-up and optimization, 27 on intraoperative management including monitoring, prophylaxis, and treatment of crisis, and 2 on postoperative management. The principal practice-shifting recommendations were that somatostatin analogues are not necessary for prophylaxis before surgery or on the day of operation, and treatment in the event of carcinoid crisis should start with vasopressors, with short-acting somatostatin analogues used as an adjunct.

Using modified Delphi methodology, recommendations to guide the perioperative management of carcinoid crisis were developed. Considering the importance of carcinoid crisis on the management and outcomes of patients undergoing surgical resection for neuroendocrine tumours, this guidance can help standardize care and optimize outcomes.