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Management of pediatric appendiceal carcinoid: a single institution experience from 5000 appendectomies

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A Letter to the Editor to this article was published on 06 January 2020

Abstract

Aim of the study

Appendiceal carcinoid (neuroendocrine tumor or NET) is a rare neuroendocrine neoplasm often found incidentally following appendectomy for appendicitis. Surgery for appendicitis is currently under scrutiny and children are increasingly managed conservatively with antibiotics alone. Herein, we aimed to review our experience with the management of appendiceal carcinoids at our institution.

Methods

Following ethical approval, we reviewed the charts of all patients who underwent appendectomy for appendicitis at our institution between 2000 and 2018. The pathology registry was consulted to identify children diagnosed with appendiceal carcinoid. Outcome measures included incidence, demographics, and management.

Main results

During the study period, 32 children (23 female) had an appendiceal carcinoid confirmed at pathology. Of these, 13 were initially treated with appendectomy (total of 5,059 appendectomies: 0.3% incidence). The other 19 had an appendectomy elsewhere by an adult general surgeon and were referred to our institution for further management. Overall, the mean age at diagnosis was 13 ± 2.7 years and all patient had a preoperative diagnosis of appendicitis, none of suspected carcinoid. Most children (75%) had acute non-perforated appendicitis. The overall mean size of the lesion was 1 ± 0.9 cm, with a > 2 cm lesion in 3 patients. Following diagnosis, 12 children (38%) underwent an ileocolic resection, due to carcinoid size, invasiveness, and margin clearance.

Conclusions

In our cohort, the incidence of appendiceal carcinoid among children with appendicitis is very low. Most carcinoids are small, located at the tip, associated with non-perforated appendicitis, and present in girls. Most were treated with appendectomy alone, with more extensive surgery performed in one third of children.

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References

  1. Pape UF, Niederle B, Costa F et al (2016) ENETS consensus guidelines for neuroendocrine neoplasms of the appendix (excluding goblet cell carcinomas). Neuroendocrinology 103:144–152

    Article  CAS  Google Scholar 

  2. Moris D, Tsilimigras DI, Vagios S et al (2018) Neuroendocrine neoplasms of the appendix: a review of the literature. Anticancer Res 38:601–611

    PubMed  Google Scholar 

  3. Vandevelde A, Gera P (2015) Carcinoid tumours of the appendix in children having appendicectomies at Princess Margaret Hospital since 1995. J Pediatr Surg 50:1595–1599

    Article  Google Scholar 

  4. Akova F, Aydin E, Nur Eray Y et al (2018) Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience. Eur J Pediatr 177:1845–1850

    Article  CAS  Google Scholar 

  5. Coursey CA, Nelson RC, Moreno RD et al (2010) Carcinoid tumors of the appendix: are these tumors identifiable prospectively on preoperative CT? Am Surg 76:273–275

    PubMed  Google Scholar 

  6. Stringer MD (2017) Acute appendicitis. J Paediatr Child Health 53:1071–1076

    Article  Google Scholar 

  7. Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51

    Article  CAS  Google Scholar 

  8. Zani A, Hall NJ, Rahman A et al (2019) European paediatric surgeons' association survey on the management of pediatric appendicitis. Eur J Pediatr Surg 29:53–61

    Article  Google Scholar 

  9. Rollins KE, Varadhan KK, Neal KR et al (2016) Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials. World J Surg 40:2305–2318

    Article  Google Scholar 

  10. Abeş M, Petik B, Kazil S (2007) Nonoperative treatment of acute appendicitis in children. J Pediatr Surg 42:1439–1442

    Article  Google Scholar 

  11. Svensson JF, Patkova B, Almström M et al (2015) Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg 261:67–71

    Article  Google Scholar 

  12. Gorter RR, van der Lee JH, Cense HA et al (2015) Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study. Surgery 157:916–923

    Article  Google Scholar 

  13. Minneci PC, Mahida JB, Lodwick DL et al (2016) Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg 151:408–415

    Article  Google Scholar 

  14. López JJ, Deans KJ, Minneci PC (2017) Nonoperative management of appendicitis in children. Curr Opin Pediatr 29:358–362

    Article  Google Scholar 

  15. Steiner Z, Buklan G, Gutermacher M et al (2018) Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible. Pediatr Surg Int 34:283–288

    Article  Google Scholar 

  16. Georgiou R, Eaton S, Stanton MP et al (2017) Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics 139:e20163003

    Article  Google Scholar 

  17. Huang L, Yin Y, Yang L et al (2017) Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis. JAMA Pediatr 171:426–434

    Article  Google Scholar 

  18. Kessler U, Mosbahi S, Walker B et al (2017) Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis. Arch Dis Child 102:1118–1124

    Article  Google Scholar 

  19. Xu J, Liu YC, Adams S et al (2016) Acute uncomplicated appendicitis study: rationale and protocol for a multicentre, prospective randomised controlled non-inferiority study to evaluate the safety and effectiveness of non-operative management in children with acute uncomplicated appendicitis. BMJ Open 6:e013299

    Article  Google Scholar 

  20. Hall NJ, Eaton S, Abbo O et al (2017) Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial. BMJ Paediatr Open

  21. Knaapen M, van der Lee JH, Bakx R et al (2017) Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial). BMJ Open 7:e018145

    PubMed  PubMed Central  Google Scholar 

  22. Njere I, Smith LL, Thurairasa D et al (2018) Systematic review and meta-analysis of appendiceal carcinoid tumors in children. Pediatr Blood Cancer 65:e27069

    Article  Google Scholar 

  23. Russell WS, Schuh AM, Hill JG et al (2013) Clinical practice guidelines for pediatric appendicitis evaluation can decrease computed tomography utilization while maintaining diagnostic accuracy. Pediatr Emerg Care 29:568–573

    Article  Google Scholar 

  24. Brody AS, Frush DP, Huda W et al (2007) Radiation risk to children from computed tomography. Pediatrics 120:677–682

    Article  Google Scholar 

  25. Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707

    Article  Google Scholar 

  26. Shah SR, Sinclair KA, Theut SB et al (2016) Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm. Ann Surg 264:474–481

    Article  Google Scholar 

  27. Boudreaux JP, Klimstra DS, Hassan MM et al (2010) The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, and cecum. Pancreas 39:753–766

    Article  Google Scholar 

  28. Kim SS, Kays DW, Larson SD et al (2014) Appendiceal carcinoids in children management and outcomes. J Surg Res 192:250

    Article  Google Scholar 

  29. Parikh PP, Perez EA, Neville HL et al (2018) Nationwide overview of survival and management of appendiceal tumors in children. J Pediatr Surg 53:1175–1180

    Article  Google Scholar 

  30. Tanaka Y, Uchida H, Kawashima H et al (2015) Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg 50:1893–1897

    Article  Google Scholar 

  31. Boxberger N, Redlich A, Böger C et al (2013) Neuroendocrine tumors of the appendix in children and adolescents. Pediatr Blood Cancer 60:65–70

    Article  Google Scholar 

  32. Virgone C, Cecchetto G, Alaggio R et al (2014) Appendiceal neuroendocrine tumours in childhood: Italian TREP project. J Pediatr Gastroenterol Nutr 58:333–338

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Chirath Ranaweera, Amanpreet Brar, Agostino Pierro & Augusto Zani

  2. Division of Pathology, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada

    Gino R. Somers

  3. Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada

    Furqan Sheikh

Authors
  1. Chirath Ranaweera
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  2. Amanpreet Brar
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  3. Gino R. Somers
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  4. Furqan Sheikh
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  5. Agostino Pierro
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  6. Augusto Zani
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Correspondence to Augusto Zani.

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Ranaweera, C., Brar, A., Somers, G.R. et al. Management of pediatric appendiceal carcinoid: a single institution experience from 5000 appendectomies. Pediatr Surg Int 35, 1427–1430 (2019). https://doi.org/10.1007/s00383-019-04575-1

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  • DOI: https://doi.org/10.1007/s00383-019-04575-1

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