Carcinoid tumours of the appendix: an analysis of emergency appendicectomies over a 24-year period and outcomes of laparoscopic versus open resection.

BACKGROUND: Carcinoid tumours of the appendix are the most common primary malignant lesion of the appendix. However, the overall incidence remains low; found in as few as 0.3-0.9% appendicectomy specimens. Almost all appendiceal carcinoids are found incidentally during surgery for suspected appendicitis.

METHODS: A retrospective review of all appendiceal carcinoids was performed in six hospitals from January 1990 until December 2013. Demographic data, operative technique, histopathological characteristics, clinic reviews and need for further treatment were recorded and compared with literature.

RESULTS: Appendiceal carcinoids were identified in 175 specimens. The mean age is 32 years (range 8-87 years), with 69 (39.4%) males and 106 (60.6%) females (P < 0.0001). Of these, 106 underwent open surgery with standard McBurney incision, nine underwent full laparotomy and 60 underwent laparoscopic surgery. Six of the laparoscopic surgeries were converted to open procedures. We recorded 159 (90.75%) classical carcinoids and 16 (9.25%) goblet cell carcinoids. Overall, 131 (75.7%) had concurrent appendicitis; classical carcinoid 72.6% versus goblet cell carcinoid 93.8%. The median size of the goblet cell carcinoids was significantly larger than classical carcinoids. Classical carcinoids were mostly distal to the base, while goblet cell carcinoids had equal distribution. It appears that the involvement of resection margins was not influenced by the surgical technique. Thirty patients required further right hemicolectomy as treatment for high-risk features; open 19 (15.9%) versus laparoscopic 11 (20.4%).

CONCLUSIONS: Laparoscopic appendicectomy did not seem to adversely influence the margin clearance in appendiceal carcinoid, though we recommend that all appendicectomies should include the mesoappendix.