Carcinoid tumors of the appendix

Forty-six carcinoid tumors of the appendix, diagnosed in surgically resected specimens during an 11 yr period (1965-1975), were reviewed to determine the features of metastasizing tumors. Of the carcinoid tumors of the appendix, 8.8% were found to metastasize to regional lymph nodes. The most reliable criterion of metastasizing tumors was the size of the primary tumor. Such tumors measured 2.0 cm or larger in greatest dimensions. Depth of invasion, extension to serosa, perineural involvement, histologic features, and location of the tumor relative to the length of the appendix were common to both the metastasizing and localized tumors. The surgical management of patients with carcinoid tumors of the appendix is controversial, ranging from a simple appendectomy to a more radical operative procedure. In the absence of distant metastases, it would appear that this group of patients with tumors 2.0 cm or more would require a right hemicolectomy rather than a simple appendectomy to accomplish removal of all disease-bearing tissue.