Abstract
Background
We present data acquired in our institution about the incidence of incidental appendiceal carcinoids over a period of 16 years. The possibility of occult carcinoids raises the question of appendectomy of a noninflamed appendix during diagnostic laparoscopy for suspected appendicitis.
Methods
We performed a retrospective chart analysis of the surgical registry of a university-affiliated tertiary care center of a major population area for the past 16 years. Data were collected on all patients (n = 7592) who underwent appendectomy for the presumed diagnosis of acute appendicitis. Outcome measures were the incidence of incidental carcinoids of the appendix found during appendectomies and whether the introduction of laparoscopic appendectomy should alter the surgical management of a normal-appearing appendix.
Results
A total of 20 carcinoid appendices were resected by open surgery and 17 by laparoscopy. The diagnosis of a carcinoid tumor was not suspected in any patient before the operation, nor was a tumor identified at the time of the operation. In 6 (16%) patients the appendix appeared normal at the time of the operation.
Conclusions
It has long been the standard of care to remove any appendix found in laparotomy for suspected appendicitis, but it is not clear what should be done during laparoscopy for suspected appendicitis when the appendix appears normal. Our data confirm the presence of occult carcinoids in normal-appearing appendices. Further studies are needed to determine the clinical significance of this finding.
Similar content being viewed by others
References
Greason KL, Rappold JF, Liberman MA (1998) Incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain. Surg Endosc 12:223–225
Van den Broek WT, Bijnen AB, de Ruiter P, Gouma DJ (2001) A normal appendix found during diagnostic laparoscopy should not be removed. Br J Surg 88:251–254
Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7, 970 appendectomies. Dis Colon Rectum 41:75–80
Goede AC, Caplin ME, Winslet MC (2003) Carcinoid tumour of the appendix. Br J Surg 90:1317–1322
Sandor A, Modlin IM (1998) A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol 93:422–428
Modlin IM, Sandor A (1997) An analysis of 8305 cases of carcinoid tumors. Cancer 79:813–829
Roggo A, Wood WC, Ottinger LW (1993) Carcinoid tumors of the appendix. Ann Surg 217:385–390
Anderson JR, Wilson BG (1985) Carcinoid tumours of the appendix. Br J Surg 72:545–546
Moertel CG, Dockerty MB, Judd ES (1968) Carcinoid tumors of the vermiform appendix. Cancer 21:270–278
MacGillivray DC, Heaton RB, Rushin JM, Cruess DF (1992) Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size. Surgery 111:466–471
Sweeney JF, Rosemurgy AS (1997) Carcinoid tumors of the gut. Cancer Control 4:18–24
Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13, 715 carcinoid tumors. Cancer 97:934–959
Olsen JB, Myren CJ, Haahr PE (1993) Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 80:922–923
Thorell A, Grondal S, Schedvins K, Wallin G (1999) Value of diagnostic laparoscopy in fertile women with suspected appendicitis. Eur J Surg 165:751–754
Walker SJ, West CR, Colmer MR (1995) Acute appendicitis: does removal of a normal appendix matter, what is the value of diagnostic accuracy and is surgical delay important? Ann R Coll Surg Engl 77:358–363
Gough IR, Morris MI, Pertnikoves EI, Murray MR, Smith MB, Bestmann MS (1993) Consequences of removal of a ‘normal’ appendix. Med J Aust 1:370–372
Ponka JL (1973) Carcinoid tumors of the appendix: report of thirty-five cases. Am J Surg 126:77–83
Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K (2009) Laparoscopic appendectomy—is it worth the cost? Trend analysis in the US from 2000–2005. J Am Coll Surg 208:179–185
Disclosures
R. Shapiro, S. Eldar, E. Sadot, M. Venturero, M. Z. Papa, and D. B. Zippel have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shapiro, R., Eldar, S., Sadot, E. et al. The significance of occult carcinoids in the era of laparoscopic appendectomies. Surg Endosc 24, 2197–2199 (2010). https://doi.org/10.1007/s00464-010-0926-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-0926-0