caa a22 4500 475803671 CHVBK 20180406123744.0 cr unu---uuuuu 170329e20001101xx s 000 0 eng 10.1007/s002680010232 doi (NATIONALLICENCE)springer-10.1007/s002680010232 Method for Dissection of Mesenteric Metastases in Mid-gut Carcinoid Tumors [Elektronische Daten] [Ulf Öhrvall, Barbro Eriksson, Claes Juhlin, Sadettin Karacagil, Jonas Rastad, Per Hellman, Göran Åkerström] With adequate medical management the midgut carcinoid tumor generally is an indolent malignancy associated with substantial life expectancy and appreciable life quality, even in the presence of liver metastases and significant tumor burden. Abdominal complications may occur in this entity of carcinoids owing to entrapment of intestines and encasement of mesenteric vessels by mesenteric metastases and associated marked mesenteric fibrosis. This may be the cause of abdominal pain, disabling diarrhea, weight loss to the extent of malnutrition, and eventually the risk of death with acute or chronic intestinal obstruction or intestinal gangrene. Operative removal of the mesentericointestinal lesion is often indicated to prevent or treat these complications but may be technically difficult when mesenteric metastases extend in the vicinity of major vessels in the mesenteric root. At laparotomy 56 patients with advanced midgut carcinoids underwent removal of the mesenteric tumor with a method for preserving the mesenteric vessels. This was feasible by mobilizing and releasing the right colon and mesenteric root from posterior adhesions, identifying the mesenteric artery below the pancreas, and free-dissecting this artery on the tumor capsule in the mobilized mesentery. Dissection was successful even with tumors initially judged inoperable unless tumor growth completely surrounded the mesenteric vessels or extended retroperitoneally. One patient was subjected to distal intestinal artery bypass. Symptom relief was been substantial and often of long duration after mesenteric tumor removal in patients who prior to surgery often had threatening intestinal ischemia. Patients with advanced midgut carcinoids may benefit markedly from dissectional removal of mesenteric tumors, which (conceivably better than conventional wedge resection) preserves the length of the remaining intestine. Société Internationale de Chirurgie, 2000 Öhrvall Ulf Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut Eriksson Barbro Department of Medicine, University Hospital, S-751 85 Uppsala, Sweden, SE aut Juhlin Claes Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut Karacagil Sadettin Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut Rastad Jonas Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut Hellman Per Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut Åkerström Göran Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut World Journal of Surgery Springer-Verlag 24/11(2000-11-01), 1402-1408 0364-2313 24:11<1402 2000 24 268 https://doi.org/10.1007/s002680010232 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002680010232 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Öhrvall Ulf Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Eriksson Barbro Department of Medicine, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Juhlin Claes Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Karacagil Sadettin Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Rastad Jonas Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Hellman Per Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 700 1- Åkerström Göran Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/11(2000-11-01), 1402-1408 0364-2313 24:11<1402 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer