The Problem of Appendiceal Carcinoids

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endocrinology

Background:

• Appendiceal neuroendocrine neoplasms (aNEs) are uncommon gastrointestinal tumors.
• Most aNEs are discovered incidentally during appendectomy and have a benign course.
• A subset of aNEs possess malignant potential, necessitating further investigation into risk stratification.

Purpose of the Study:

• To review and highlight controversies in the epidemiology of aNEs.
• To critically assess current workup and management algorithms for aNEs.
• To explore future research directions and advances in understanding aNEs.

Main Methods:

• Review of existing literature on appendiceal neuroendocrine neoplasms.
• Analysis of current international guidelines and their evidential basis.
• Discussion of clinical controversies and future research needs.

Main Results:

• Appendectomy is curative for most aNEs, but risk stratification for malignant potential remains challenging.
• Current guidelines for additional surgery (e.g., right hemicolectomy) lack robust evidence.
• There is a need for accurate predictive factors to guide surgical decisions in high-risk aNE patients.

Conclusions:

• Management of aNEs requires careful consideration due to their variable clinical behavior.
• Further research is crucial to establish evidence-based guidelines for risk assessment and treatment.
• Advances in understanding aNEs will improve patient outcomes and surgical decision-making.