Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix in a National Cohort: A Call...

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Children with appendiceal neuroendocrine tumors (NET) are often treated with right hemicolectomy (RHC) based on adult guidelines.
• Appendectomy alone is recommended for pediatric cases, but its safety with positive margins is not well-established.

Purpose of the Study:

• To evaluate the association between tumor characteristics and survival in a national cohort of pediatric patients with appendiceal NET.
• To determine if appendectomy alone is a safe and effective treatment, even in the presence of high-risk features like positive margins.

Main Methods:

• A national cohort of 1,339 patients aged 18 years or younger with appendiceal NET was identified (2004-2022).
• Patient data from the National Cancer Database were analyzed, comparing outcomes between appendectomy and RHC.
• Five-year survival rates were assessed for appendectomy patients with and without high-risk features (size, margin, lymph node status).

Main Results:

• Appendectomy was performed in 86% of patients (1,156) versus RHC in 14% (183).
• Patients undergoing RHC had larger tumors and more lymphovascular invasion, but margin status showed no difference.
• Overall 5- and 10-year survival rates were excellent (99.9% and 99.4%), including for those treated with appendectomy alone (99.9% and 99.2%).

Conclusions:

• Appendectomy is confirmed as the definitive management for pediatric appendiceal NET.
• Further resection (RHC) does not improve survival outcomes, even with positive margins on appendectomy specimens.