F. A. Ahmed1, V. S. Wu2, H. Kakish1, M. Elshami1, L. Ocuin1, L. Rothermel1, R. Hoehn1 1University Hospitals Cleveland Medical Center, Surgical Oncology, Cleveland, OHIO, USA 2Case Western Reserve University School Of Medicine, Cleveland, OH, USA
Introduction:
The surgical approach for 1-2cm neuroendocrine tumor (NET) of the appendix has been a subject of debate. Some studies have indicated appendectomy alone is sufficient, but many patients still go on to receive right hemicolectomy to complete surgical staging. We investigated recent national trends and outcomes for patients with these intermediate tumors.
Methods:
We queried the National Cancer Database (2004-2018) for patients with 1-2cm neuroendocrine tumors of the appendix. Patients were categorized according to the type of surgery, appendectomy or hemicolectomy. Multivariable Cox proportional hazard regressions and logistic regressions were used to identify factors associated with overall survival and surgical approach.
Results:
Of the 3,189 patients included, 1,616 (50.7%) underwent appendectomy alone. The rate of appendectomy has increased in recent years, from 37.7% in 2004 to 58.9% in 2018. On adjusted analysis, appendectomy alone was not associated with a difference in survival (HR:0.95, 95% CI= 0.65-1.40). On subset analysis, appendectomy was associated with worse survival for patients with high-grade tumors (p=0.031) but not for intermediate (p=0.454) and low-grade (p=0.443) tumors. On multivariable analysis, high-grade tumors were associated with an increased likelihood of undergoing right hemicolectomy (appendectomy OR:0.41, 95% CI=0.26-0.66). There were no significant correlations between other patient and hospital factors with surgical approach.
Conclusion:
Treatment with appendectomy alone for 1-2 cm appendiceal NETs has increased in recent years without adverse impact on overall survival. Patients with high-grade tumors may benefit from hemicolectomy, but most others may be spared the more invasive surgery.
