what are the after effects of laproscopic liver resection for carcinoid disease?

Answer 1

Carcinoid is a strange class of tumor that can behave in a variety of ways, and it depends to some extent on where it originates.

Carcinoid tumors most commonly originate in one of two places, in the gastrointestinal tract (often near the appendix) or in the lung. Other sites are possible but these are the most common. Carcinoid tumors can secrete chemicals that tend to affect the performance of blood vessels. This problem, termed "carcinoid syndrome" is a result of a neurotransmitter/hormone called seratonin which is released in sufficient quantity that it stimulates receptors in the muscular walls of blood vessels. Carcinoid syndrome manifests as diarrhea and "flushing", i.e., redness of the upper chest, arms and face.

Since the liver does a great job of deactivating seratonin which comes in the blood stream from the gastrointestinal tract, presence of the carcinoid syndrome typically indicates that either the tumor burden and the seratonin secretion from the GI tract is too high for the liver to deactivate, or the tumor has spread to the liver and is releasing its seratonin downstream into the systemic blood flow.

Once carcinoid or carcinoid syndrome has overcome the liver, there is probably a significant amount of disease. Surgical management may be undertaken to control symptoms even though the plan for controlling the disease will still be predominantly medical. Other methods for controlling carcinoid syndrome include specific anti-seratonin medications (cyproheptadine) and anti-hormone medications (somatostatin).

When metastatic lesions are found in the liver associated with gastrointestinal cancer, the current thinking is that these can be resected (removed) irrespective of number, as long as a reasonable plan for removing the diseased liver segments can be performed while preserving enough liver tissue that the body's needs will be met by what's left. Fortunately for us, the liver tends to regrow!

Sometimes, in planning a liver resection for metastatic disease, the first step in the operation is to more closely evaluate the liver itself. Once past the abdominal wall, an ultrasound probe can be applied to the surface of the liver, and tiny spots of abnormal tissue may be found. If so, these should be biopsied. There is probably no benefit to attempting a curative operation knowing that small cancer lesions in the liver are about to regrow. However, it is also possible that the removal of a single large lesion of carcinoid tumor can be used as part of an effective measure to relieve carcinoid syndrome, even if there are remaining micro-focuses of disease which can be supressed medically. These decisions would have to be discussed between surgeon and patient.

As to the question of laparoscopy...

Laparoscopic surgery is essentially no different than open surgery. The same principles apply. Laparoscopic technique involves making small incisions and working through them with thin instruments and a videoscope, but once in place, the same operations should be performed. The benefit to making small incisions is that patients recover more quickly, and some evidence suggests that the lower stress on the system may help reduce the risk of stress-related physiologic changes which predispose to surgical complications such as infection.

The number of surgeons willing to approach a hepatic metastectomy for carcinoid, laparoscopially, is probably pretty small. If you are working with such a surgeon on this problem, you are probably working with an academic expert and a leader in the field. This surgeon could probably answer your specific questions far more accurately than I! Please consider asking them.

Answer 2

pain is not uncommon, and the feeling of bloating.....cancer seeding is possible but not always expected after laparoscopic procedure...belly doc's answer is more complete than any search engines there is.