¿Se justifica la hemicolectomia en carcinoides apendiculares de 2 cm?

Un análisis retrospectivo realizado en el Hospital General de Boston publicado este año en Archives of Surgery concluye que no es necesario realizar una hemicolectomia derecha en caso de carcinoides apendiculares mayores de 2,0 cm. Los autores manifiestan que la apendicectomía sería suficiente.

Is Right Hemicolectomy for 2.0-cm Appendiceal Carcinoids Justified?
Zubin M. Bamboat, MD; David L. Berger, MD
Arch Surg. 2006;141:349-352.

Hypothesis We believe right hemicolectomy (RHC) is not necessary in patients with an appendiceal carcinoid greater than 2.0 cm.

Design A retrospective review of patients with a histologically confirmed appendiceal carcinoid from April 1, 1980, to February 28, 2005, and an analysis of the literature.

Setting Tertiary care referral center.

Patients Forty-eight patients (34 females and 14 males) with a histologically confirmed diagnosis of appendiceal carcinoid were included in the study. Appendiceal carcinoid was diagnosed incidentally in all 48 patients. Patient ages ranged from 11 to 86 years (mean age, 41 years). Postoperative follow-up and disease-free survival were confirmed in 33 patients via medical record review.

Main Outcome Measures We assessed the relationship between survival, tumor size, and the role of RHC vs appendectomy alone.

Results Four patients in our series underwent secondary RHC and lymph node dissection for tumors greater than 2.0 cm, and none had positive lymph nodes. Following review of the literature, we were unable to find any recent evidence of distant metastasis from carcinoids in patients already treated by appendectomy. There seem to be no conclusive data to support the notion that RHC confers a survival benefit over appendectomy for carcinoids greater than 2.0 cm.

Conclusion Appendiceal carcinoids greater than 2.0 cm can be managed effectively with simple appendectomy, given their low malignant potential and slow growth, obviating the need for RHC in this group of patients without affecting overall survival.


Author Affiliations: Department of Surgery, Massachusetts General Hospital, Boston.