Problems in the management of the appendiceal carcinoid tumors

Backgraund: Carcinoid tumor is the most common type of neuroendocrine tumor. Appendix is one of the most common sites of gastrointestinal carcinoid tumors. Appendectomy may be performed without mesoappendix excision by some surgeons in general practice. In that case, what happens, if a carcinoid tumor turns out to be responsible for the symptoms? In our series, this practice and carcinoid cases were discussed. Methods and Findings: Carcinoid tumor cases that were operated on between the years 2002-2010 were examined retrospectively. Average age, female-male ratio, location of the tumor, invasion to the mesoappendix, inflammatory changes, and management of the cases were discussed. The number of carcinoid cases was 6 (0,29%). Average tumor size was (0,2-1,4)cm. None of the cases had clinical signs of carcinoid syndrome. In one case, microinvasion was detected in periappendiceal fatty tissue at the mesoappendicular side. But mesoappendix had not been removed in the operation, therefore, lymphadenopathy could not be evaluated by the pathologist. Conclusions: The carcinoid syndrome is diagnosed by biochemical tests. If the tumor is greater than 1cm in diameter or is in the base of the appendix, or if there is evidence of nodal metastases, a right hemicolectomy is recommended. In five cases, appendectomy alone was thought to be enough, however, the case that was shown to have mesomicroinvasion was evaluated by MRI, colonoscopy, octreotid scintigraphy and biochemical tests. Extended resection was not performed and the case was followed more than a year. To date nothing suggestive of residual tumor or the like was detected.