SURVIVAL AND DAILY PHYSICAL-ACTIVITY IN PATIENTS TREATED FOR ADVANCEDMIDGUT CARCINOID-TUMORS

Background, Prospects for survival and quality of life ought to influe nce treatment strategies in patients with midgut carcinoids. Methods. A total of 121 patients with midgut carcinoid received a combined medi cal and surgical treatment from 1980 to 1993. In all, 158 operations w ere undertaken for removal of mesentericointestinal lesions and occasi onal liver metastases or as repeat intervention for abdominal complica tions. Survival was analyzed together wish estimates of daily physical activity during follow-up. Results, Cause of death (63 patients) incl uded carcinoid heart disease (41%) and cachexia (mesentericointestinal entrapment, 35%). Median survival was 11 years In patients with irres ectable mesenteric metastases, 7 years with liver metastases, and 1 ye ar with extraabdominal spread. Extensive liver metastases or substanti al weight loss (9 kg or greater) reduced survival to a median of 4 to 5.5 years, and surgically treated intestinal ischemia reduced survival to a median of 8 years. Patients with carcinoid syndrome survived a m edian 7 years, those with 5-hydroxyindoleacetic acid values greater th an 500 mu mol/24 hr or a valvular heart disease survival a median of 5 years, those with heart failure a median of 2.5 years. Most patients retained an acceptable daily physical activity; impairment occurred in cases of malnutrition, high 5-hydroxyindoleacetic acid values, or hea rt valve fibrosis, and activity was markedly reduced in the presence o f extraabdominal metastases or overt heart disease. Conclusions. Favor able survival statistics and the maintenance of daily physical activit y support active medical and surgical management in patients with adva nced midgut carcinoids.