In a long-term study of 150 unselected patients with carcinoid tumors of the appendix, we found that the neoplasms were usually less than 1.0 cm in largest dimension and discovered as an incidental finding during surgery performed for other reasons. Metastases were observed with none of the 127 appendiceal carcinoids less than 2.0 cm in largest dimension, with 3 of the 14 lesions greater than or equal to 2.0 cm but less than 3.0 cm in greatest dimension, and with 4 of the 9 lesions greater than or equal to 3.0 cm. Paradoxically, the patients with the larger tumors and metastases were younger than those with smaller and clinically benign tumors. The median age of patients with tumors greater than or equal to 2.0 cm was 31 years and that of those with metastases was 29 years, as compared with a median age of 42 years in patients with nonmetastasizing tumors less than 2.0 cm. We conclude that simple appendectomy is adequate treatment for patients with apparently localized tumors less than 2.0 cm in largest dimension. We have not observed any recurrences or metastases among 122 such patients followed for a median time of more than 26 years. Simple appendectomy is probably also appropriate treatment for lesions greater than or equal to 2.0 cm in elderly patients or in those at high operative risk. Right hemicolectomy seems justified only in young patients with tumors greater than or equal to 2.0 cm who have a low risk of operative morbidity or mortality. Vascular involvement and invasion of the mesoappendix are features that may favor a more radical approach.
Source Information
Department of Oncology, Mayo Clinic, Rochester, MN 55905.
This article has been cited by other articles:
Pinchot, S. N., Holen, K., Sippel, R. S., Chen, H.
(2008). Carcinoid Tumors. The Oncologist
13: 1255-1269
[Abstract][Full Text]
Ardill, J. E S
(2008). Circulating markers for endocrine tumours of the gastroenteropancreatic tract. Ann Clin Biochem
45: 539-559
[Abstract][Full Text]
Landry, C. S., Woodall, C., Scoggins, C. R., McMasters, K. M., Martin, R. C. G. II
(2008). Analysis of 900 Appendiceal Carcinoid Tumors for a Proposed Predictive Staging System. Arch Surg
143: 664-670
[Abstract][Full Text]
Scarsbrook, A. F., Ganeshan, A., Statham, J., Thakker, R. V., Weaver, A., Talbot, D., Boardman, P., Bradley, K. M., Gleeson, F. V., Phillips, R. R.
(2007). Anatomic and Functional Imaging of Metastatic Carcinoid Tumors. RadioGraphics
27: 455-477
[Abstract][Full Text]
Turner, G B, Johnston, B T, McCance, D R, McGinty, A, Watson, R G P, Patterson, C C, Ardill, J E S
(2006). Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours. Gut
55: 1586-1591
[Abstract][Full Text]
Bamboat, Z. M., Berger, D. L.
(2006). Is Right Hemicolectomy for 2.0-cm Appendiceal Carcinoids Justified?. Arch Surg
141: 349-352
[Abstract][Full Text]
Ramage, J K, Davies, A H G, Ardill, J, Bax, N, Caplin, M, Grossman, A, Hawkins, R, McNicol, A M, Reed, N, Sutton, R, Thakker, R, Aylwin, S, Breen, D, Britton, K, Buchanan, K, Corrie, P, Gillams, A, Lewington, V, McCance, D, Meeran, K, Watkinson, A, on behalf of UKNETwork for neuroendocrine tumours,
(2005). Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut
54: iv1-iv16
[Full Text]
Kaltsas, G. A., Besser, G. M., Grossman, A. B.
(2004). The Diagnosis and Medical Management of Advanced Neuroendocrine Tumors. Endocr. Rev.
25: 458-511
[Abstract][Full Text]
Lepage, C, Bouvier, A M, Phelip, J M, Hatem, C, Vernet, C, Faivre, J
(2004). Incidence and management of malignant digestive endocrine tumours in a well defined French population. Gut
53: 549-553
[Abstract][Full Text]
Pickhardt, P. J., Levy, A. D., Rohrmann, C. A. Jr, Kende, A. I.
(2003). Primary Neoplasms of the Appendix: Radiologic Spectrum of Disease with Pathologic Correlation. RadioGraphics
23: 645-662
[Abstract][Full Text]
Pickhardt, P. J., Levy, A. D., Rohrmann, C. A. Jr, Kende, A. I.
(2002). Primary Neoplasms of the Appendix Manifesting as Acute Appendicitis: CT Findings with Pathologic Comparison. Radiology
224: 775-781
[Abstract][Full Text]
Pickhardt, P. J., Levy, A. D., Rohrmann, C. A. Jr., Abbondanzo, S. L., Kende, A. I.
(2002). Non-Hodgkin's Lymphoma of the Appendix: Clinical and CT Findings with Pathologic Correlation. Am. J. Roentgenol.
178: 1123-1127
[Abstract][Full Text]
Kulke, M. H., Mayer, R. J.
(1999). Carcinoid Tumors. NEJM
340: 858-868
[Full Text]
(1988). CARCINOID TUMORS OF THE APPENDIX: TREATMENT AND PROGNOSIS. JWatch General
1988: 8-8
[Full Text]
Previous
