Appendiceal neuroendocrine neoplasms in the era of laparoscopic appendicectomy

Incidental appendiceal neuroendocrine neoplasms are identified in 1% of surgical resections for suspected appendicitis. A proportion of these patients will require further surgery because of high risk features, which include mesoappendiceal involvement or an involved margin. While an open appendicectomy technique usually involves en bloc mesoappendiceal resection, the increasingly common laparoscopic method often skeletonizes the appendix, leaving the mesoappendix in situ. This retrospective observational study investigates whether routine resection of the mesoappendix rather than skeletonization would reduce the need for further surgery in patients with an incidental finding of appendiceal neuroendocrine neoplasm.

We included appendicectomies performed over an 11-year period at Auckland City Hospital and identified all cases of incidental appendiceal neuroendocrine neoplasms. Histological data were collected to assess the risk of lymphatic spread and need for further surgery. Mesoappendix resection versus preservation and its effect on the recommendation for further surgery was recorded.

An appendiceal neuroendocrine neoplasm was present in 73 (1%) of 7109 appendicectomy specimens. Of these, 10 patients (14%) required right hemicolectomy. Five of these could potentially have been spared the need for further surgery had the mesoappendix been removed en bloc with the appendix.

We recommend en bloc mesoappendix resection during appendicectomy in order to better stage the neoplasm and reduce the need for unnecessary further surgery.