Appendiceal Neuroendocrine Tumors: Does Colon Resection Improve Outcomes?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Appendiceal neuroendocrine tumors (A-NETs) are rare gastrointestinal neoplasms.
• Current management of A-NETs primarily relies on tumor size, with limited understanding of surgical strategy's impact on outcomes.

Purpose of the Study:

• To evaluate the impact of surgical resection strategy on short- and long-term outcomes for appendiceal neuroendocrine tumors (A-NETs).

Main Methods:

• Retrospective analysis of 61 patients with A-NET undergoing resection across 8 institutions (2000-2016).
• Clinicopathologic features and outcomes were stratified based on surgical approach: appendectomy versus formal colonic resection.

Main Results:

• Appendectomy was performed in 51% of patients, colonic resection in 49%.
• The colonic resection group had a higher incidence of positive lymph nodes (27%) and advanced disease (M1, 3%).
• Complications (30% vs 6%, p=0.02), length of stay, blood loss, and operative time were significantly higher in the colonic resection group, despite similar R0 resection rates (90% vs 97%) and outcomes (RFS, OS).

Conclusions:

• Recurrence-free survival (RFS) and overall survival (OS) for A-NETs are comparable irrespective of surgical approach.
• Formal colonic resection is associated with increased morbidity and resource utilization compared to appendectomy.
• Further research is needed to identify specific patient subgroups who may benefit from more aggressive surgical interventions.