Surgical Treatment of Malignant Carcinoid Tumours of the Appendix

M. E. O'Donnell; J. Carson; W. I. H. Garstin

Disclosures

Int J Clin Pract. 2007;61(3):431-437. 

In This Article

Results

Eleven patients with malignant carcinoid-type tumours of the appendix were identified from April 1994 to December 2003. There were eight females (mean age 54, range 14-81) and three males (mean age 28, range 16-45).

Six patients presented with acute appendicitis with or without abscess formation. All patients proceeded to simple appendicectomy and drainage of abscess as appropriate. Two patients with confirmed caecal malignancies had the appendix excised as part of a right hemicolectomy. The appendix was removed incidentally in a further three patients during primary procedures for ovarian tumours, small bowel obstruction (SBO) and gastrointestinal haemorrhage.

A total of nine patients were identified with classical carcinoid tumours (CCT); (M = 3 and F = 6, mean age 43, range 14-81). Five of these patients had primary CCT of the appendix following appendicectomy for acute appendicitis, and one patient had a primary CCT of the appendix following subtotal colectomy for a gastrointestinal bleed. The remaining three patients had secondary CCT involvement of the appendix from caecal, small bowel and ovarian primaries, respectively. Two further patients were identified with goblet-cell carcinoid tumours (GCCT) (F =, age 46 and 76). One patient had a primary GCCT following appendicectomy for acute appendicitis, whereas the other patient with GCCT has secondary involvement of the appendix from a caecal primary. See Table 1 for patient data.

Mean follow-up was 63 months (range 1-125 months). Nine patients remain well to date with no evidence of tumour recurrence or disease progression. Two patients died in the postoperative period; Patient 7 was admitted 8 months after her initial surgery with further SBO secondary to GCCT recurrence. She was treated palliatively and died from bronchopneumonia during the same admission. Patient 9 diagnosed with a CCT died on day 8 following operative intervention for a perforated duodenal ulcer.

Even though it appeared that females did not do as well as males, this difference was found to be nonsignificant (log rank, p = 0.59). Cox Model regression analyses for other predictors of mortality were nonsignificant (age, type of surgery - elective vs. emergency, haematological indices - white cell count and C-reactive protein).

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