INDICATIONS FOR RIGHT HEMICOLECTOMY IN CARCINOID-TUMORS OF THE APPENDIX

The records of 181 patients with carcinoid tumor of the appendix, seen during a ten year period (1977 to 1987), were analyzed retrospectivel y to determine the indications for right colectomy and the significati on of intermediate histopathologic forms. Appendectomy was the only tr eatment in 146 patients; while right hemicolectomy was performed upon 35 patients-in seven patients with one postoperative death initially a nd in 28 patients without any death or morbidity, secondarily. Colecto my was indicated initially in seven patients for bulky tumors of the b ase of the appendix invading the cecum or for associated carcinoma of the right colon. The 28 secondary colectomies were indicated for tumor s that were statistically larger and more invasive than those treated by simple appendectomy or for intermediate forms, or both, in five ins tances. There were rive instances of residual tumor on secondary hemic olectomy specimens. In 11 of the 181 carcinoid tumors (6 percent), the intermediate type tumor was associated with mucinous production-seven adenocarcinoids and four carcinoids with mucocele. Of the seven insta nces of adenocarcinoid, there was one death at two years and one patie nt is alive with metastases. Other than size greater than 2 centimeter s and base localization, the results of the current study suggest that the presence of mucinous production cells is a further indication for secondary right hemicolectomy.