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Laparoscopic resection of primary midgut carcinoid tumors

机译：腹腔镜切除原发性中肠类癌

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Background: Laparoscopic intestinal surgery is the preferable technique for the majority of intestinal surgical disorders. However, no series on laparoscopic resection of intestinal midgut carcinoid tumors (MCTs) has been reported to date. This is related to the rarity of these tumors as well as the technical difficulties resecting the large mesenteric root lymph node mass commonly found with these tumors and the occasional difficulty identifying the primary MCT, which may be small and undetected on preoperative imaging studies. This is the first series to report the results for laparoscopic resection of MCT. Methods: All consecutive patients with MCT (excluding appendiceal carcinoid tumor) between 2002 and 2012 underwent laparoscopic resection. The patient's clinical data, preoperative endocrine workup, imaging studies, operative data, final histology, and outcome were recorded and analyzed. Results: During the study period, 35 patients underwent surgery for primary intestinal carcinoid tumor. Of the 35 patients, 20 (12 women and 8 men ages 26-86 years) had surgery for primary MCT, and the remainder had a colorectal carcinoid tumor. In the MCT group, ten patients had liver metastases at the time of surgery. In three patients, multiple synchronous MCTs were detected intraoperatively. All the patients underwent a laparoscopic resection with en bloc resection of the corresponding mesenteric root mass. No conversion to open surgery was needed, and no major morbidity occurred. Two patients (10 %) each experienced minor morbidity with wound infection and prolonged ileus. The median hospital length of stay was 6 days (range 4-9 days). During a follow-up period of 3-96 months, no patients experienced local or regional recurrence. No distant metastases were detected during the follow-up period in any patients who had surgery with intent to cure. Conclusion: Although technically difficult, laparoscopic resection of primary MCTs is feasible and safe, with the additional known significant advantages of laparoscopic surgery in general. Similar to the large-scale prospective studies that proved the oncologic safety of laparoscopic surgery for colorectal cancer, this small series showed that the laparoscopic technique also may be oncologically safe for these rare tumors.
机译：背景：腹腔镜肠外科手术是大多数肠外科疾病的首选技术。然而，迄今为止尚无关于腹腔镜切除肠中肠类癌（MCTs）的系列报道。这与这些肿瘤的稀有性以及切除这些肿瘤常见的大肠系膜根部淋巴结肿块的技术难度以及偶尔确定原发性MCT的难度有关，后者可能很小且在术前影像学检查中未发现。这是第一个报告MCT腹腔镜切除结果的系列文章。方法：2002年至2012年间所有连续的MCT患者（不包括阑尾类癌）均接受腹腔镜切除术。记录并分析患者的临床资料，术前内分泌检查，影像学检查，手术资料，最终组织学和结局。结果：在研究期间，有35例因原发性肠类癌进行了手术。在这35名患者中，有20名（12名女性和8名男性，年龄在26-86岁之间）接受了原发性MCT手术，其余患者患有结直肠类癌。在MCT组中，有十名患者在手术时发生肝转移。在三例患者中，术中检测到多个同步MCT。所有患者均进行了腹腔镜切除，并整体切除了相应的肠系膜根部肿块。无需转换为开放手术，也没有发生大的发病率。两名患者（10％）均因伤口感染和肠梗阻延长而发病率较低。中位住院时间为6天（4-9天）。在3-96个月的随访期内，没有患者出现局部或区域性复发。在随访期间，所有有治愈意图的手术患者均未发现远处转移。结论：尽管在技术上很困难，但腹腔镜手术切除原发性MCT仍是可行和安全的，并且通常具有腹腔镜手术的其他已知显着优势。与证明腹腔镜手术对结直肠癌的肿瘤学安全性的大规模前瞻性研究相似，该小系列研究表明，腹腔镜技术对这些罕见肿瘤也可能在肿瘤学上是安全的。

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