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Is Right Hemicolectomy for 2.0 cm Appendiceal Carcinoids Justified

Zubin M Bamboat, David L Berger
Massachusetts General Hospital, Boston, MA

Objective: To challenge the necessity for right hemicolectomy (RHC) in patients with appendiceal carcinoid greater than 2.0 centimeters.
Design: A retrospective review of patients with histologically confirmed appendiceal carcinoid from April 1980 to February 2005 and analysis of the literature.
Setting: Tertiary care referral center.
Patients: Forty-eight patients (34 females and 14 males) with histologically confirmed diagnosis of appendiceal carcinoid were included in the study. The diagnosis of appendiceal carcinoid was made incidentally in all 48 patients. Patient ages ranged from 11 to 86 years with a mean age of 41. Post-operative follow up and disease free survival was confirmed in 33 patients via chart review.
Main Outcome Measures: We assessed the relationship between survival, tumor size, and the role of RHC vs. appendectomy alone.
Results: Four patients in our series underwent secondary RHC and lymph node dissection for tumors greater than 2 centimeters and none had positive lymph nodes. Following review of the current literature, we were unable to find any evidence of distant metastasis from carcinoid in patients already treated by appendectomy. There appears to be no conclusive data to support the notion that RHC confers a survival benefit over appendectomy for carcinoids greater than 2 centimeters.
Conclusions: Appendiceal carcinoids greater than 2 centimeters can be managed effectively with simple appendectomy given their low malignant potential and slow growth obviating the need for RHC in this group of patients without impacting overall survival.

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