Frequency, characteristics and outcomes of appendicular neuroendocrine tumors: A cross-sectional study from an academic tertiary care hospital.

BACKGROUND: Appendicular neuroendocrine tumors (NET, Carcinoid tumors) of the appendix are rare and mostly diagnosed incidentally on the post-operative histopathological examination. NET are usually associated with good 5-year survival rates. We aimed to assess our experience for the diagnosis and management of NET over 11 years.

METHOD: It is a retrospective chart review of all clinically suspected patients with acute appendicitis who underwent emergent appendectomy with intention to treat between January 2004-December 2014, and were clinically followed up until 2016.

RESULTS: During the study period, a total of 13641 patients underwent emergency appendectomy, of which 32 were histologically confirmed NET. The mean age of the NET cases was 25.3 ± 7.9 years; 78% were males and all were clinically presented with acute appendicitis. The mean leucocyte was 15 ± 14 × 109 per Liter, and mean tumor size was 4.86 ± 3.18 (ranged 1.5-13) mm. The median length of hospital stay was 4 (2-15) days. One patient had right hemicolectomy; diagnosed with right colonic cancer with NET being an incidental finding as part of histopathological assessment. Another patient required a second stage procedure; he was diagnosed as goblet cell carcinoid with positive margin. None of the patients died 30-day postoperatively and all of them survived on clinical follow-up that ranged between 2 and 13 years.

CONCLUSION: Carcinoid tumors of the appendix are rare and typically diagnosed incidentally. Detailed examination of routine appendectomy specimens is the key for diagnosis. Simple appendectomy suffices for tumors <2 cm for adequate clearance. Appendicular carcinoid tumors are associated with good long-term outcomes.