Endocrine Abstracts

Objective: Appendiceal carcinoid is an uncommon neuroendocrine condition that can potentially give rise to a variation in management. We aimed to assess the occurrence and mode of presentation of carcinoid tumour of appendix, and any variation of its management.

Methods: All appendicectomies that took place at a single institute between January 1995 and December 2005 were considered for study.

Results: A total of 1941 appendicectomies took place. Sixteen (0.82%) patients had carcinoid tumours. Occurrence of the female was higher amongst the carcinoid tumour group (n=11; 68.8% of 16), than non-carcinoid group (n=867; 45.0% of 1925) (P=0.58). Mean age of patients with carcinoid tumour (41.8 years) was significantly higher than those with non-carcinoid pathology (27.7 years) (P=0.001). None of the carcinoid tumour was identified at the operation. One patient (6.6%) required right hemicolectomy. Eight patients as well as their general practitioners (53.3%) were unaware of the diagnosis. Three patients had associated synchronous lesions, which were noted incidentally. Multidisciplinary team involvement or speciality referral took place in three cases (20%). Indications of involving multidisciplinary team lacked uniformity. Follow-ups were often inconsistent with the guidelines of UKNETwork for neuroendocrine tumours, varied widely quantitatively as well as qualitatively, and took place in three (20%) cases only. No screening for metachronous and synchronous lesions took place.

Conclusions: Carcinoid tumour of appendix remained an incidental diagnosis, with trend of increased occurrence amongst the female. Patients with carcinoids were significantly older than non-carcinoid conditions. Reoperation rate was low. There was a wide variation in involving the multidisciplinary team, conveying the diagnosis to patients as well as their general practitioners, and follow-ups. This can be perceived as a missed opportunity of selective screening of synchronous and metachronous lesions, raises clinical governance issues and has medicolegal implications.