Are we missing diagnostic opportunities in cases of carcinoid tumours of the appendix?

Abstract

Carcinoid tumour of appendix is an uncommon 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. All appendicectomies that took place at North Middlesex University Hospital, London between 1995 and 2005 were considered for study. A total of 1941 appendicectomies took place. Sixteen (0.82%) patients had carcinoid tumours. The 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). The incidence of female patients was higher than the male amongst the carcinoid tumour group (female/male ratio 2.2). None of the carcinoid tumours were identified at operation. Eight patients as well as their general practitioners (53.3%) were unaware of the diagnosis. Multidisciplinary team involvement or specialty referral took place in three cases (20%). One patient (6.6%) required right hemicolectomy. Three patients (20%) were followed-up in inconsistent manner. Carcinoid tumour of the appendix remains an incidental diagnosis. Patients with carcinoids were significantly older than non-carcinoid conditions. There was a trend of increased occurrence of carcinoids amongst the females. Re-operation 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.