Peri-operative management of patients with carcinoid syndrome: insights from a cancer specific centre — ASN Events
  1. Schedule
  2. Joint Poster Session
  3. Peri-operative management of patients with carcinoid syndrome: insights from a cancer specific centre

Peri-operative management of patients with carcinoid syndrome: insights from a cancer specific centre (#403)

Sitra Yusuf 1 , Emma Boehm 1 2 , Grace Kong 2 3 , Hui Li Wong 3 4 , Michael Michael 2 3 , Wing Fai Rebecca Nip 2 , Leeanne Pasanen 2 , Cherie Chiang 1 5
  1. Department of Internal Medicine, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
  2. Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
  4. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  5. Department of Diabetes and Endocrinology, Melbourne Health, Melbourne, Victoria, Australia

Carcinoid crisis is an endocrine emergency characterised by haemodynamic instability in patients with neuroendocrine tumours (NET) who have carcinoid syndrome (CS). It is usually triggered by surgical procedures but has been reported post PRRT and chemotherapy. There is a lack of evidence-based guidelines on how these patients should be evaluated and managed in the peri-operative period. At the Peter MacCallum Cancer Centre, Australia's only public hospital solely dedicated to cancer care, we aim to reduce length of stay (LOS) and improve peri-operative outcomes by developing and implementing a peri-operative protocol for patients with CS. 

Patients with NET who underwent a surgical procedure between January 2017 – January 2024 were retrospectively identified. Data extraction included patient demographics, NET grade, presence of carcinoid heart disease, urine 5 HIAA and somatostatin analogues (SSA) use.

Pre-protocol implementation, 1371 patients with NET underwent 555 procedures. 48 patients were diagnosed with CS and underwent a total of 71 procedures. 94% of patients had grades 1 or 2 NET. 38% of patients were prescribed long-acting SSA therapy pre-procedure. Prophylactic octreotide infusion was used in 22 procedures. Carcinoid crisis occurred in 9.9% of all procedures, LOS was 14.7 ± 6.9 days in those with crisis compared to those without (3.8 ± 1.6) days (P< 0.001).

A multi-disciplinary team including oncologists, nuclear medicine physicians, endocrinologists and anaesthetists evaluated the baseline data, developed and published a conceptual framework to stratify perioperative risk for carcinoid crisis using three parameters: 1) procedure related risk, 2) tumour secretory burden and 3) hormonal control (1).  The peri-operative protocol was introduced in early 2025 with > 320 downloads. In the 12 months post implementation, there were 421 patients with Gastroenteropancreatic NET who had 44 procedures. Detailed post implementation data analysis is underway to evaluate the impact of the peri-operative protocol.

  1. (1) Del Olmo-García M, Kong G, Wong H, Michael M, Ismail H, Nip WF, Pasanen L, Chiang C. Exploring the carcinoid crisis: insights from a cancer-specific centre. Endocr Oncol. 2025 Dec.