caa a22 4500 477035310 CHVBK 20180405111303.0 cr unu---uuuuu 170330e19960701xx s 000 0 eng 10.1007/s002689900137 doi (NATIONALLICENCE)springer-10.1007/s002689900137 Progression of Metastases and Symptom Improvement from Laparotomy in Midgut Carcinoid Tumors [Elektronische Daten] [Charlie Makridis, Jonas Rastad, Kjell Öberg, Göran Åkerström] Abstract. A total of 121 consecutive patients with midgut carcinoid tumors underwent regular clinical control and 158 laparotomies for abdominal symptoms with 1 to 11 years (mean 5.2 years) of follow-up. Metastases were present in 93% of the patients at study inclusion and developed at initially uninvolved sites with an overall probability of 0.38. Patients without initial tumor spread developed mesenteric or liver metastases with the probability of 0.25 (mean delay 12 years), whereas those with mesenteric metastases exhibited a probability 0.56 to develop liver metastases (mean delay 6.1 years). Spread to extraabdominal sites in patients with mesenteric and liver metastases exhibited a probability of 0.22 (mean delay 4.3 years), and this spread was especially frequent (probability 0.60) in patients with only liver metastases at inclusion. Patients without the carcinoid syndrome (52%) mainly suffered from more or less episodic abdominal pain, nausea, and diarrhea. Marked mesenteric fibrosis detected at surgery (: n = 59) generally was accompanied by symptoms of abdominal pain and weight loss, and it often required urgent intervention due to intestinal obstruction or ischemia. Complete or partial symptom alleviation was accomplished in 82% of the operated patients, and generally was most auspicious after primary acute or subacute procedures ( n = 54). The complete or partial symptom improvements after surgery lasted for mean 5.3 years and tended to be longer after elective ( n = 50) than acute operations. The findings substantiate encouraging results of laparotomy in a compromised cohort of patients with midgut carcinoid tumors. Because the patients also displayed a generally slow progression of metastases, liberal indications for laparotomy should prevail in symptomatic and possibly also asymptomatic individuals with midgut carcinoid tumors. 1996 by the Société Internationale de Chir, ugie Makridis Charlie 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 Öberg Kjell Department of Internal Medicine, University Hospital, S-751 85 Uppsala, Sweden, SE aut Åkerström Göran Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden, SE aut https://doi.org/10.1007/s002689900137 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900137 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Makridis Charlie 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- Öberg Kjell Department of Internal Medicine, 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 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer