title: Management and outcomes of appendicular neuroendocrine tumours: Retrospective review with 5-year follow-up.
abstract: BACKGROUND
  Neuroendocrine (NEN) tumours are the commonest type of tumours affecting the appendix. The majority of cases are diagnosed incidentally on post-operative histopathological examination of the resected appendicectomy specimen. Preoperative diagnosis remains a challenge, unless the patient presents with obvious features of carcinoid syndrome or signs of metastatic disease. Hence, the authors present our five-year experience in diagnosing and managing NEN tumours of the appendix.
  
  
  METHODS
  Retrospective review of all patients underwent an emergency appendicectomy with intention to treat clinically suspected appendicitis at Derriford Hospital (Plymouth, Devon, UK) was undertaken. Patients with diagnoses other than NEN of the appendix were excluded. For patients with appendicular NEN, demographic data, pre-operative inflammatory markers, post-operative histology results as well as follow-up investigations were obtained using patients' electronic records. Case notes were reviewed for clinical presentation, operative details and follow-up information.
  
  
  RESULTS
  2724 patients underwent emergency appendicectomy between January 2009 and May 2014. Carcinoid tumours were identified in 17 histologically examined appendicectomy specimens. Clinically, all patients presented with acute appendicitis with raised inflammatory markers in 58.5% of patients. Median tumour size was 5 (1-20) mm. Median postoperative follow up was 2.9 (0.92-5.8) years. All patients remained tumour free with no evidence of metastasis or recurrence during the entire study period.
  
  
  CONCLUSIONS
  Appendicular NEN are rare and usually diagnosed incidentally; hence precise examination of routine appendicectomy specimens is fundamental in the diagnosis. Simple appendicectomy is sufficient for tumours less than 1 cm for adequate clearance, whilst right hemi-colectomy is recommended for larger tumours.
authors.affiliation: Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Amr
authors.affiliation: Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom. Electronic address: farid.froghi@nhs.net.
authors.forename: F
authors.initials: F
authors.lastname: Froghi
authors.affiliation: Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Edmond
authors.affiliation: Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Haq
authors.affiliation: Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Thengungal Kochupapy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy; D001063:Appendiceal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D001064:Appendicitis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002276:Carcinoid Tumor / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003082:Colectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
keywords: Appendicitis; Carcinoid; Neuroendocrine tumours