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Introduction
Small bowel carcinoids account for 42% of neuroendocrine tumors within the GI tract. The finding of these tumors should be followed by an in-depth search for additional primary tumors which may be found in a third of patients. These can only be detected by close inspection and palpation in many cases. Traditionally, laparoscopic resections are regarded as inadequate since they negate the ability to evaluate the small bowel in a tactile fashion and therefore carry the risk of incomplete resection and missed primary tumors. Here we present a retrospective review from a single institution by comparing laparoscopic hand assisted (LHA) and open small bowel resection for carcinoid tumor.
Methods
A retrospective review of 243 patients that underwent either open or laparoscopic hand assisted small bowel resection for carcinoid tumor between October 1999 and October 2010 was performed. The incidence of carcinoid related postoperative diarrhea, mean number of tumors resected, mean number of lymph nodes resected and median disease free survival was compared between both groups.
Results
A total of 243 patients were included in this cohort: (225 open, 18 Laparoscopic hand-assisted). Median follow up was 670 days. Mean number of resected primary tumors was 3.4 and 5.3 for open and LHA, respectively (p value=0.03) . Mean number of resected lymph nodes was comparable among the groups (11 for open and 14 for LHA, p value= 0.23). Postoperative carcinoid related diarrhea was also comparable among both groups (open 49%, LHA 61%, p value=1.0). The 5 year disease free survival was 58.5% for the open group and 67.7% for the LHA group (p value=0.18). There was no statistical significance between the groups in mean number of lymph nodes resected, postoperative diarrhea, or 5 year disease free survival, however, there was a statistical difference in the mean number of resected tumors favoring the LHA group.
Conclusion
Laparoscopic hand assisted small bowel resection for carcinoid tumors is a safe alternative with comparable outcomes to the open technique.