Surgical treatment of gastrointestinal carcinoid tumours

Surgical treatment of carcinoid tumours of the gastrointestinal tract is still debated. On the basis of a review of 4191 cases reported in the literature which included 16 cases treated in our Institution the Authors outline the possibility to standardize surgical management. Five year-survival rate was higher (>80%) in carcinoid tumours of appendix and rectum than in gastroduodenal, ileal or colonic neoplasms (<60%). Long term prognosis was affected by lymphnode involvement and distant metastases. Nodal and distant metastases were more frequently detected in gastroduodenal (50.7%) and colonic (69.7%) tumours as compared to rectum (14.1%) or appendix (4.2%) lesions. The following criteria should be considered whenever surgical treatment is planned: 1. site (gastric/jejunal/colonic vs appendix/rectum), size (<2 cm vs >=2 cm) and multicentricity are important prognostic factors; 2. conservative procedures are curative for tumours of <2 cm of diameter localized in the stomach, duodenum and lower rectum; 3. more radical locoregional procedures are recommended for tumours of any size involving the ileum or for rectal carcinoids involving muscular layers; 4. carcinoids of appendix greater than 2 cm require a right colectomy.