Surgical management of primary appendiceal malignancy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Primary appendiceal neoplasms are rare.
• Carcinoid tumors are more common than appendiceal carcinomas.
• Preoperative diagnosis of appendiceal neoplasms is infrequent.

Purpose of the Study:

• To report on a series of 24 primary appendiceal neoplasms.
• To compare the clinical presentation and outcomes of appendiceal carcinoma and carcinoid tumors.

Main Methods:

• A 5-year prospective review of primary appendiceal neoplasms diagnosed at a university teaching hospital.
• Analysis of clinical, operative, and pathological data from patient records.

Main Results:

• Fourteen appendiceal carcinomas and 10 carcinoids were identified.
• Carcinomas presented at a median age of 55.8 years with a median symptom duration of 35 days, versus 48 years and 3 days for carcinoids.
• Appendiceal carcinoma had a poor prognosis with 5 deaths during follow-up, while carcinoids had no recorded deaths or metastases.

Conclusions:

• Appendiceal carcinomas have a more protracted clinical course than carcinoids.
• Diagnosis of simple appendicitis requires caution in older patients with prolonged symptoms and abdominal mass.
• Completion right-hemicolectomy is advised for appendiceal carcinoma.