Obesity Surgery

, Volume 21, Issue 2, pp 151–156

High Incidence of Appendix Carcinoid Tumors Among Candidates for Bariatric Surgery: Diagnostic and Therapeutic Implications

  • Nicola Crea
  • Giacomo Pata
  • Ernesto Di Betta
  • Amin Titi
  • Francesco Mittempergher
Clinical Report

DOI: 10.1007/s11695-010-0112-4

Cite this article as:
Crea, N., Pata, G., Di Betta, E. et al. OBES SURG (2011) 21: 151. doi:10.1007/s11695-010-0112-4

Abstract

Although the appendix has been recognized as a preferential site for carcinoid tumors in obese patients, no definitive guidelines are so far available regarding the management of these patients when candidates for bariatric surgery. This study was designed to fill that gap. Between 2000-2008, 558 patients underwent bariatric procedures. Appendectomy was routinely performed in 477 cases. Their charts were retrospectively retrieved and histopathology responses on surgical specimens were recorded. We aimed to assess: incidence of appendix carcinoid tumors (ACTs) and any possible risk-factor; modality of diagnosis (pre-, intra- or post-operatively); impact on the planned bariatric procedure; treatment reserved to such cases. Typical ACTs were diagnosed in 7 patients (1.4%) (median age: 33 years; median BMI: 49 kg/m²; males/females: 1/6). Four were diagnosed intra-operatively. Because of dimensions (<2 cm) and absence of mesoappendiceal or serosal involvement, simple appendectomy was performed during bariatric procedure, as planned. Three were diagnosed post-operatively (all <2 cm). In 1 case right hemicolectomy was performed 1 month later due to mesoappendiceal involvement. No appendectomy-related complication was encountered. All patients remained tumor-free during follow-up (mean: 64 months; range, 25-92). Young age, female sex, high BMI and diabetes mellitus resulted significantly associated with ACT. Our study sustains routine appendectomy or at least careful investigation of the appendix during bariatric surgery. For tumors <2 cm without mesoappendiceal or serosal involvement, simple appendectomy proved sufficient. Bariatric surgery did not have a negative effect on the treatment of malignancies that are discovered intra- or post-operatively.

Keywords

AppendixCarcinoid tumorsObesitySurgeryManagement

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Nicola Crea
    • 1
  • Giacomo Pata
    • 1
  • Ernesto Di Betta
    • 1
  • Amin Titi
    • 1
  • Francesco Mittempergher
    • 1
  1. 1.Department of Medical and Surgical Sciences, 1st Division of General SurgeryUniversity of BresciaBresciaItaly