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Clinical value of right hemicolectomy for appendiceal carcinoids using pathologic criteria

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Abstract

Background: Appendiceal carcinoids (AC) are usually adequately treated by appendectomy. The European Neuroendocrine Tumours Society (ENETS) has recently reconsidered the previous pathologic criteria to identify patients at high risk of extra-appendiceal disease, who are thought to require right hemicolectomy (RHC). Aim: The aim of this retrospective, observational study was to evaluate previous and currently introduced criteria, in identifying patients with AC in whom RHC is justified. Subjects and methods: Twelve patients who underwent RHC for AC were retrospectively identified. Demographic and follow-up data were collected and appendectomy specimens were reviewed for the presence of indications leading to RHC defined as: tumor diameter ≥2 cm, tumor location at the base, mesoappendiceal extension, mitotic index Ki-67≥2%. RHC specimens were examined to identify evidence of extra-appendiceal disease, remaining and/or metastatic disease. Results: Four patients fulfilled two criteria and 8 one criterion for RHC. Two patients had tumors ≥2.0 cm, 5 located at the base, 8 invading the mesoappendix and periappendiceal fat; Ki-67 PI was 1% in all cases measured except one, in which it was 3%. Post-RHC, 3 patients (25%) had extra-appendiceal disease (no residual disease was identified in surgical margins); 1 had tumor at the colon specimen and 2 had lymph node metastasis. All 3 patients fulfilled only one pathologic criterion; 1 had tumor mesoappendiceal extension and 2 tumor location at the base of the appendix. Conclusions: Applying previous and currently introduced pathologic criteria, 25% of high-risk patients with AC had identifiable extra-appendiceal disease following RHC that might be not detected following the recently introduced ENETS criteria.

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Authors and Affiliations

  1. Endocrine Unit, Department of Pathophysiology, Laiko University Hospital, Athens Medical School, Mikras Asias 75, 115 27, Athens, Greece

    K. I. Alexandraki MD, PhD, MSc, MSc & G. A. Kaltsas

  2. 1st Department of Surgery, Laiko University Hospital, Athens Medical School, Greece

    J. Griniatsos, K. I. Bramis, N. Ballian, N. Dimitriou, C. Tsigris & E. Felekouras

  3. 1st Department of Internal Medicine, Agii Anargiri Cancer Hospital, Athens, Greece

    T. Giannakakis

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  1. K. I. Alexandraki MD, PhD, MSc, MSc
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  2. J. Griniatsos
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  3. K. I. Bramis
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Correspondence to K. I. Alexandraki MD, PhD, MSc, MSc.

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Alexandraki, K.I., Griniatsos, J., Bramis, K.I. et al. Clinical value of right hemicolectomy for appendiceal carcinoids using pathologic criteria. J Endocrinol Invest 34, 255–259 (2011). https://doi.org/10.1007/BF03347081

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