THE INCIDENCE, MANAGEMENT, AND OUTCOME OF PATIENTS WITH GASTROINTESTINAL CARCINOIDS AND 2ND PRIMARY MALIGNANCIES

BACKGROUND: A higher than expected incidence of second primary maligna ncies in patients with gastrointestinal carcinoids has been reported, How patients with such concurrent neoplasms should be managed and whet her or not the discovery of an incidental carcinoid at the time of ope ration for another malignancy affects patient management or outcome, h as never been previously addressed, STUDY DESIGN: We retrospectively r eviewed our 20-year experience with gastrointestinal carcinoid tumors with the purpose of determining the appropriate management and eventua l outcome of patients with these multiple malignancies, RESULTS: Sixty -nine patients with carcinoids of the gastrointestinal tract were disc overed, of whom 29 (42 percent) had second synchronous tumors and thre e (4 percent) had metachronous tumors, The gastrointestinal tract acco unted for 42.9 percent of the tumors, and carcinoma of the colon and r ectum was found in seven (21.9 percent) of 32 patients, None of the 29 patients with a second synchronous tumor presented with symptoms refe rable to their carcinoid, each of which was incidentally discovered: n ine at autopsy and 20 at laparotomy for the treatment of other tumors, All of the 20 surgical patients had the gastrointestinal carcinoids r esected for cure, although three had histopathologic criteria for inva sion, None of the 29 patients died as a result of, had recurrence of, or had their postoperative therapy altered by the carcinoid diagnosis, CONCLUSIONS: Gastrointestinal carcinoid is associated with a high inc idence of second primary malignancy, 46 percent in this study, The mos t common site for the second primary malignancy in these patients is t he gastrointestinal tract, suggesting a site specific predisposition t o malignant degeneration, Most gastrointestinal carcinoids are inciden tally discovered at laparotomy or autopsy, The discovery of an asympto matic gastrointestinal carcinoid during the operative treatment of ano ther malignancy will usually only require resection without additional treatment and will have little affect on the prognosis of the individ ual.