Metastatic carcinoid tumors—are we making the cut?

BackgroundAlthough controversial, surgical resection for metastatic carcinoid tumors (MCTs) can potentially prolong survival.MethodsPatients with MCTs were identified from the Surveillance, Epidemiology and End Results database. Patients undergoing surgery were compared to unresected patients.ResultsSurgery was performed in 33% of patients. Predictors of surgery included age <50 years (odds ratio [OR], 2.4), low grade (OR, 3.1), and the appendix (OR, 36.2) or small intestine (OR, 27.2) as the primary site. Predictors of adverse survival included high grade (hazard ratio, 2.4) and no surgery (hazard ratio, 2.5) or surgery on only primary or distant disease (hazard ratio, 1.5) compared with surgery for both. Survival at 5 years was 5% with no surgery, 28% with surgery on either site, and 46% with surgery at both sites (P < .001).ConclusionsSurgery for MCTs is more common in younger patients, those with low-grade disease, and those with small bowel or appendiceal primary tumors. Although selection bias cannot be excluded, these data lend support to “debulking” for MCT.