Is right hemicolectomy for 2.0-cm appendiceal carcinoids justified?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Appendiceal carcinoids are rare neuroendocrine tumors.
• The standard surgical management for larger appendiceal carcinoids often includes right hemicolectomy (RHC).

Purpose of the Study:

• To evaluate the necessity of RHC for appendiceal carcinoids greater than 2.0 cm.
• To compare survival outcomes between RHC and appendectomy alone for these tumors.

Main Methods:

• Retrospective review of 48 patients with histologically confirmed appendiceal carcinoid.
• Analysis of literature regarding tumor size, RHC, and survival.
• Assessment of the relationship between survival, tumor size, and surgical approach.

Main Results:

• No positive lymph nodes were found in four patients who underwent secondary RHC for tumors >2.0 cm.
• No recent evidence of distant metastasis was found in patients treated with appendectomy alone.
• No conclusive data supports a survival benefit of RHC over appendectomy for carcinoids >2.0 cm.

Conclusions:

• Simple appendectomy is an effective management for appendiceal carcinoids >2.0 cm.
• The low malignant potential and slow growth of these tumors obviate the need for RHC.
• Appendectomy alone does not affect overall survival in patients with appendiceal carcinoids >2.0 cm.