Yavuz ALBAYRAK, Ayetullah TEMİZ, Sevilay AKALP ÖZMEN

APENDİKS’İN KARSİNOİD TÜMÖRÜ: 3981 APENDEKTOMİ VAKASININ DEĞERLENDİRİLMESİ

Bu çalışmanın amacı acil apendektomilerde insidental olarak karşılaştığımız apendiks karsinoid tümörlerininsıklığı ve tedavi yöntemlerini tartışmaktır.Gereç ve Yöntem: 2008 Eylül – 2016 Eylül tarihleri arasında Erzurum Bölge Eğitim ve araştırma hastanesindeklinik ve radyolojik olarak Akut apandisit tanısı konularak ameliyata alınan ve patolojik sonucu Akutapandisit olarak rapor edilen 3981 hastanın dosyaları elektronik ortamda incelendi. Patolojik olarak Karsinoidtümör tanısı konulan hastalar analize edildi.Bulgular: 2008 Eylül ayı ile 2016 Ağustos ayları arasında ki 8 yıl boyunca toplam 3981 hastaya apendektomiyapıldı ve bu hastaların içerisinde 21(%0.53) hastaya histopatolojik olarak karsinoid tümör tanısı konuldu.Hastaların 11 i erkek 10 u ise kadındı. Hastaların yaş ortalaması 33.7 idi. Ameliyattan önce hiçbir hastayakarsinoid tümör tanısı konulmamıştı ve de spesmenlerin ameliyat sonrası incelenmesi sonucunda tanı konulmuştu.Hastaların tümü acil olarak opere edilmişti. Hastaların hiç birinde karsinoid sendrom bulgularıolan diyare ve flushing gibi semptomlar mevcut değildi. Tümör hastaların 18 inde apendixin Uç kısmında, 2sinde appendixin ortasında ve 1 inde de appendixin taban kısmında idi. Tümör çapı 12 hastada 1 cm denküçük, 5 hastada 1-2 cm arasında ve 4 hastada ise 2 cm den büyüktü. Hastaların 4 üne ikinci bir operasyongerekmişti ve sağ hemikolektomi yapılmıştı. Sağ hemikolektomi yapılan hastaların tümör çapı 2 cm denbüyüktü ve hiç birinde uzak metastaz tespit edilmemişti.Sonuç: Karsinoid tümörler apendiksin en sık görülen tümörüdür. Karsinoid tümörler insidental olarak tespitedildiğinden dolayı patoloji sonuçları çok iyi takip edilmelidir. Çapı 1 cm den küçük olan tümörlerde apendektomi,1-2 cm olan tümörlerde; tümör apendixin kökünde değil ve mezoapendix invazyonu yoksa apendektomi,varsa sağ hemikolektomi, 2 cm den büyük olan tümörlerde ise sağ hemikolektomi yapılmalıdır.

Carcinoid Tumor Of Appendix: Evaluatıon of 3981 Appendectomy Cases

Objective: The aim of this study is to discuss the frequency and treatment methods of appendicitis carcinoid tumors that we encounter incidentally in emergency appendectomies. Material and Methods: The files of 3981 patients who were diagnosed as acute appendicitis clinically and radiologically and reported as acute appendicitis as a result of pathology in Erzurum Region Education and Research Hospital between September 2008- September 2016 were rewieved electronically. Patients diagnosed with carcinoid tumor were pathologically analyzed. Findings: A total of 3981 patients underwent appendectomy for 8 years between September 2008 and August 2016 and these patients, 21 (0.53%) were histopathologically diagnosed as carcinoid tumors. 11 of the patients were male and 10 of the patients were female. The mean age of the patients was 33.7. Before the operation, none of the patients had carcinoid tumor diagnosis and the diagnosis was made as a result of examination of the specimens after the operation. All of the patients were operated immediately. Symptoms such as diarrhea and flushing were not present in any of the patients with carcinoid syndrome findings. The tumor was located at the tip of the appendix of 18 patients, in the middle of the appendix of 2 patients and at the base of the appendix of 1 patient. Tumor diameter was smaller than 1 cm in 12 patients, 1-2 cm in 5 patients, and larger than 2 cm in 4 patients. A second operation was required for 4 patients and right hemicolectomy was performed. Patients who underwent right hemicolectomy had a tumor size larger than 2 cm in diameter and no distant metastases were identified. Discussion: Carcinoid tumors are the most common tumor of appendix. Since carcinoid tumors are incidentally identified, the pathology results should be followed very carefully. Appendectomy in tumors smaller than 1 cm in diameter, in 1-2 cm tumors; appendectomy should be performed if the tumor is not at the root of the appendix and if there is no mezoappendix invasion but if there is, right hemicolectomy should be performed in tumors larger than 2 cm in diameter.

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