Carcinoid tumour of the appendix.
BACKGROUND
Appendiceal carcinoid tumours are found in 0.3-0.9 per cent of patients undergoing appendicectomy. Controversy exists over the management following appendicectomy, especially with regard to the role of right hemicolectomy in patients with tumours smaller than 2 cm in diameter.


RESULTS
The literature pertaining to the behaviour of appendiceal carcinoids was reviewed in order to formulate indications for right hemicolectomy. Metastatic disease from appendiceal carcinoids is a rare occurrence, but is more common when lesions are larger than 2 cm in diameter. The risk-benefit balance of right hemicolectomy needs to be better defined, and an improved understanding of tumour cell biology may aid prognostic accuracy and decision-making.


CONCLUSIONS
There is limited evidence on which to base clear indications for right hemicolectomy in patients with a diagnosis of appendiceal carcinoid. Acceptable indications are carcinoids larger than 2 cm in size, any high-grade malignant carcinoid (including those with a high mitotic index), mesoappendiceal invasion, lesions at the base of the appendix with tumour-positive margins, and goblet cell adenocarcinoid tumours.
University Department of Surgery, Royal Free Hospital and University College London Medical School, London, UK. agoede@rfc.ucl.ac.uk
A C
AC
Goede
M E
ME
Caplin
M C
MC
Winslet
D001063:Appendiceal Neoplasms / Q000473:pathology / Q000601:surgery*; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis; D011379:Prognosis