Appendiceal Carcinoid / Well Differentiated Neuroendocrine Neoplasm / Tumor
Clinical
- Five year survival
- Confined to appendix 90%
- Local invasion or metastases to lymph nodes 80%
- Organ metastases 30%
- Carcinoid syndrome is usually present only if the liver is involved by metastases
- 4% of patients also have a small intestinal carcinoid
- Indications for hemicolectomy for carcinoid (if noted at time of appendectomy)
- >2 cm in greatest dimension
- Involvement of mesoappendix
- Transection
- Lymph node involvement
- Recommendations for re-opening the patient for right colectomy if tumor noted after closure
- If <1 cm and margins clear, no further surgery
- If 1-2 cm consider right colectomy if:
- Deep mesoappendiceal invasion (>3 mm)
- Margins not clearly negative
- Vascular invasion
- If >2 cm, recommend right colectomy
- Metastatic workup should be performed before above decisions made.
