Laparoscopic versus open resection for appendix carcinoid

Abstract

Background: Since an increasing number of appendectomies are performed via laparoscopy, it is crucial to determine the impact of this approach on appendix carcinoid (AC) outcome. The goal of this study was to compare results of laparoscopic (LAP) versus open (OP) appendectomy for AC according to intend to treat approach. Methods: A retrospective review (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) identified 39 patients (median age, 36 years; range, 12-83) treated by laparoscopy (LAP) or laparotomy (OP) for AC in a single institution. Follow-up was complete for all patients (median, 67 months; range, 4-132). Results: Most cases had associated acute appendicitis (64%). Median carcinoid size was 1.1 cm (range, 0.3-5) and 0.4 cm (range, 0.2-3) in the LAP and OP groups, respectively. LAP and OP were performed in 21 (54%) and 18 (46%) patients, respectively. Surgical margins were positive in two patients in the LAP group and one patient in the OP group (p = 0.6). Right colectomies were performed for AC >2 cm in five patients after LAP and in four patients after OP (p = 0.9). Actuarial 5-year survival rates were 100 and 94% in the LAP and OP groups, respectively (p = 0.2). Two patients died in the OP group, one due to metastatic carcinoid and the other due to metachronous colorectal cancer. Synchronous or metachronous colorectal carcinomas developed in six patients (15%). Conclusion: Laparoscopic appendectomy is a safe procedure for AC, with carcinologic and long-term results similar to those of conventional appendectomy. Thus, pre-or per-operative suspicion of AC is not a contraindication to LAP. Prognosis of AC appears more dependent on carcinoid malignant potential or associated tumors. Risk for developing colorectal adenocarcinoma is high in AC patients and warrants follow-up of all patients with colonoscopic screening.

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

“…Moreover, wound protectors only protect the abdominal wall from tumor cells seeding, but doe not offer any protection against cells seeding in the abdominal cavity when the colon is extracted through a small incision for proximal bowel preparation. The use of a laparoscopic retrieval bag for the extraction of the resected specimen has been shown to decrease the incidence of wound infection at the extraction incision and lower the risk of seeding of tumor cells into the abdominal cavity and wound metastasis during specimen manipulation [31][32][33]. For TLCCA a specimen retrieval bag is used for these reasons and allows easy handling of the resected bowel segment for extraction through the right iliac port incision.…”

Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Tumours: Well-Differentiated Tumour/Carcinoma of the Appendix and Goblet Cell Carcinoma

“…All patients should be asked to undergo repeated colonoscopy or, if available, colon CT (with neutral enema) for screening of synchronous or metachronous tumours [33,39] .…”

Laparoscopic Right Hemicolectomy for Goblet-Cell Carcinoid of the Appendix: Report of a Rare Case and Literature Survey

“…17 As evidence of the benefits associated with laparoscopic appendectomy accumulates, an increasing number of resections for appendiceal tumors are being performed by laparoscopy, and data from some studies indicate that laparoscopic appendectomy for the management of appendix neoplasms is associated with long-term results comparable to those obtained with the open appendectomy. 18 In our institute, we have performed laparoscopic hemicolectomies in about 200 patients over the last 12 years. Our case report adds to the existing data regarding the safety of laparoscopy for malignant appendiceal neoplasm.…”