Frequency, characteristics and outcomes of appendicular neuroendocrine tumors: A cross-sectional study from an academic tertiary care hospital

Abstract

BackgroundAppendicular neuroendocrine tumors (NET, Carcinoid tumors) of the appendix are rare and mostly diagnosed incidentally on the post-operative histopathological examination. NET are usually associated with good 5-year survival rates. We aimed to assess our experience for the diagnosis and management of NET over 11 years.MethodIt is a retrospective chart review of all clinically suspected patients with acute appendicitis who underwent emergent appendectomy with intention to treat between January 2004–December 2014, and were clinically followed up until 2016.ResultsDuring the study period, a total of 13641 patients underwent emergency appendectomy, of which 32 were histologically confirmed NET. The mean age of the NET cases was 25.3 ± 7.9 years; 78% were males and all were clinically presented with acute appendicitis. The mean leucocyte was 15 ± 14 × 109 per Liter, and mean tumor size was 4.86 ± 3.18 (ranged 1.5–13) mm. The median length of hospital stay was 4 (2–15) days. One patient had right hemicolectomy; diagnosed with right colonic cancer with NET being an incidental finding as part of histopathological assessment. Another patient required a second stage procedure; he was diagnosed as goblet cell carcinoid with positive margin. None of the patients died 30-day postoperatively and all of them survived on clinical follow-up that ranged between 2 and 13 years.ConclusionCarcinoid tumors of the appendix are rare and typically diagnosed incidentally. Detailed examination of routine appendectomy specimens is the key for diagnosis. Simple appendectomy suffices for tumors <2 cm for adequate clearance. Appendicular carcinoid tumors are associated with good long-term outcomes.

Appendicular Neuroendocrine Neoplasm is Associated with Acute Appendicitis - Don't Miss the Boat

“…In our cohort, majority of tumours were located in body and base of appendix (54.5%). This is contrary to other studies, where over 90 % of ANEN are located at the tip of appendix (14) However, our study corresponds with other studies, where over 80% of neuroendocrine neoplasms are well differentiated (14).…”

“…Incidence of incidental ANET was 0.70% in our series. This corresponds to other studies, where incidence was 0.08% to 1.6% (11)(12)(13)(14)(15).…”

“…Our study confirms that ANEN is more common in 2nd and 3rd decade of life, with female preponderance (14,16,17).…”

Carcinoid Tumors of Appendix Presenting as Acute Appendicitis

“…Most carcinoid tumors are located at the tip of the appendix, and they are usually less than1 cm but rarely larger than 2 cm in diameter. [1,2] In the present study, we reported a series of 12 appendiceal carcinoid tumors detected after emergency appendectomy at our clinic.…”

Carcinoid tumours of the appendix: an analysis of emergency appendicectomies over a 24‐year period and outcomes of laparoscopic versus open resection

“…[1][2][3][4][5][6] However, the overall incidence remains low; found in as few as 0.3-0.9% appendicectomy specimens. [3][4][5][6][7][8] Almost all appendiceal carcinoids are found incidentally on appendicectomy, and rarely are diagnosed before surgery for suspected appendicitis. [3][4][5][6]8,9 Appendiceal carcinoids typically behave in a benign manner and metastases are uncommon.…”