The management of carcinoid tumors must be individualized based on the findings at surgery. Which of the following is/are components of optimal care?

b. Careful exploration of the remaining small bowel and colon

c. Non-anatomic resection of small multiple liver metastases

Operative management of a primary small bowel carcinoid tumor involves principals similar to those of small bowel carcinomas. Wide en bloc excision should include as many lymphatic drainage pathways as possible because of their frequent metastatic involvement. Because of the increased incidence of both multicentricity and a second unrelated malignancy, a diligent search for other primary carcinoids of the small bowel and for other synchronous malignancies of other organs is imperative. When localized hepatic metastasis are amenable to resection, hepatic resection should be considered to minimize the potential development of Carcinoid Syndrome. Adjuvant postoperative chemotherapy for patients with metastatic carcinoid tumor is of modest benefit with response rates in the 20–30% range with median duration response short-lived. At present, adjuvant therapy is confined only to those patients with Carcinoid Syndrome.