Appendectomy or Right Hemicolectomy in the Treatment of Appendiceal Carcinoid Tumors?

Abstract

According to current guidelines, an appendectomy may be performed for small carcinoid tumors (<1 cm). Reasons for more extensive surgery than appendectomy are tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. The criteria that direct us towards major (hemicolectomy) or minor surgery (appendectomy) are controversial. Tumor size is still considered the most important prognostic factor, with a presumed increase in the risk of metastasis for tumors greater than 2.0 cm. The accepted treatment of such tumors is a right hemicolectomy. However, there is no evidence demonstrating a survival benefit for right hemicolectomy over simple appendectomy in patients with carcinoids greater than 2.0 cm in diameter.

Appendiceal neuroendocrine neoplasms: diagnosis and management

“…Approximately 60-80% of aNENs are localised at the tip of the appendix, 5-21% in the body and 7-10% at the base (Roggo et al 1993, Prommegger et al 2002, Safioleas et al 2005, Fornaro et al 2007. Because an incomplete resection is most likely to occur at the base of the appendix, such lesions are more likely to develop local recurrence compared to those located at the tip following a simple appendicectomy (Sutton et al 2003, Alexandraki et al 2011.…”

“…In a series of 64 young patients diagnosed when !40 years old and followed for 10-33 years after operation, only one recurrence was documented in 1 patient with a tumour O2 cm and local metastases (Svendsen & Bulow 1980). In a small series of seven patients, only one patient, with a tumour O2 cm with MAI and LN metastasis, who underwent a RHC, developed liver metastases 6 years after the operation but survived after a liver resection (Fornaro et al 2007). Lung metastases were also reported 2 years after RHC in one patient with MAI (Safioleas et al 2005).…”

Carcinoid tumor of the appendix detected incidentally

“…Tümör davranışını belirlemede tümör büyüklüğü, lenf nodu varlığı, histolojik alttipi, tümör pozitif cerrahi sınır, yüksek mitotik indeksle sellüler pleomorfizm ve mezoapendiks yayılımı önemlidir. [9][10][11] Mitotik indeks 10 büyük büyütmede genellikle %1'den daha az görülmektedir. Eğer 10 büyük büyütmede iki veya üç bulunursa prognoz oldukça kötüdür.…”

Neoplasias Malignas Primarias Del Apéndice Cecal: Estudio Comparativo Entre 2 Hospitales Regionales

“…Esto es importante para determinar la conducta y el tratamiento del paciente 25 La conducta quirúrgica en las neoplasias del apéndice cecal son bastantes contradictorias y aún no existe acuerdo que permita orientar al cirujano sobre cuál es el tratamiento ideal 18 . Se recomienda realizar hemicolectomía derecha en pacientes con nET cuyo tamaño supere los 2 cm, infiltre mesoapéndice, exista compromiso del ciego o presente alto índice mitótico, sin embargo, no se ha llegado a un consenso en los criterios 26 . A pesar del desacuerdo, la sobrevida de este tipo de cáncer apendicular alcanza el 99% a los 5 años.…”