Abstract
Carcinoid crisis is a potentially fatal condition described as the acute development of hemodynamic instability with or without the symptoms of carcinoid syndrome, such as diarrhea, flushing, and bronchoconstriction. Patients with neuroendocrine liver metastases exhibit higher rates of carcinoid syndrome and carcinoid crisis, since the secretion of bioactive substances bypasses hepatic metabolism. Carcinoid crisis may arise during procedural and therapeutic interventions, such as the administration of chemotherapeutic agents or peptide receptor radionuclide therapy, anesthesia, tumor biopsies, and tumor manipulation during surgery. As there are many scenarios in which therapeutic interventions are performed for patients with neuroendocrine tumors, an understanding of the management of carcinoid syndrome and intraoperative carcinoid crisis is essential. Patients who experience carcinoid crisis are at higher risk of postoperative complications including stroke, heart attacks, acute kidney injury, and hepatic injury. Treating carcinoid crisis requires a timely and coordinated strategy due to its sudden onset and acute hemodynamic changes. While the mainstay of treatment has historically been the administration of somatostatin analogues, the pathophysiology and optimal management of carcinoid crisis remain poorly understood. There is marked heterogeneity in the regimens used in clinical practice, and recent studies have investigated the use of prophylactic and routine octreotide to prevent crisis episodes. This chapter examines whether routine administration of octreotide is effective to prevent intraoperative carcinoid crisis.