Intraoperative carcinoid crisis in NET operations – Eluding Dogma with current understanding

Surgical resection remains the definitive management for patients with neuroendocrine tumors (NET), and patients with metastatic disease involving the liver are no exception. Complicating this critical operation is the potential for intraoperative hemodynamic instability, most commonly sudden and profound hypotension, historically termed ‘carcinoid crisis’ but quite variably defined in the literature. These events result in hypoperfusion of major organ systems leading to stroke, myocardial infarction and even death from circulatory collapse.