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recent series report rather different findings; in one case series, including eight patients who had a completion right hemicolectomy (RHC) in aNENs <1 cm in diameter, LN involvement was found in a single patient (12.5%); larger tumours ≥2 cm had a 57
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Many clinicians prefer to avoid surgery in patients with carcinoid neoplasia, because of its slow growth and relatively favourable prognosis. Nevertheless, the commonest cause of death in patients with carcinoid is advanced metastatic disease, and both clinical and epidemiological data indicate that the more effectively the disease is ablated, the more long-lasting the benefit. Multidisciplinary management of patients with carcinoid must consider inherited risk, possible multiple carcinoids and/or synchronous non-carcinoid cancer, and the use of a range of investigations that also evaluate the 10% of patients with carcinoid syndrome with or without valvular heart disease. Although primary size is correlated with the presence of nodal with or without liver metastases, carcinoid tumours <1 cm in diameter may be metastatic at presentation, particularly those arising within the small intestine. In the jejunum and ileum, resection of all sizes of carcinoid with local and regional nodes is preferred, to prevent nodal dissemination causing mesenteric ischaemia with or without infarction. Resection of nodal metastases should be undertaken in those with persistent or recurrent nodal disease if possible. Appendiceal and right colonic carcinoids are most effectively treated by right hemicolectomy with local and regional nodal clearance, as for adenocarcinoma. However, for most appendiceal carcinoids which are <1 cm in diameter and non-invasive, appendicectomy alone is sufficient. For appendiceal carcinoids 1-2 cm in diameter, histopathological assessment helps to determine the need for hemicolectomy. Liver resection has been followed by prolonged 5 year survival in several series and is recommended in appropriate patients to attempt cure or to debulk metastatic disease. Liver transplantation has had only qualified success in highly selected patients without extra-hepatic disease in whom other therapies have failed.
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treatment-related colonic perforation and required an emergent right hemi-colectomy. She was removed from the study on the date of surgery and died 13 days later. Table 3 Laboratory adverse events. Laboratory adverse events a Number of
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appendicitis. When the tumour is at the base of appendix, or ≥20 mm diameter, or shows >3 mm mesoappendiceal invasion, or histology suggests goblet cell (adenocarcinoid), a right hemicolectomy (open or laparoscopic) with locoregional lymphadenectomy is usually
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assessed as stable disease following previous resection (right hemicolectomy (<1 cm small intestinal NET: n =1), pancreas resection (<1 cm insulinomas: n =2)) and were currently not receiving any treatment. Three (7%) of the age: sex matched control group
