376 Neoplasms of the Appendix- Are They Managed Appropriately?
A H Amir, T M Chia, M Choy, L O'Connell, B Meshkat, E Nugent, M Joyce, M Regan, A Hogan- Surgery
Abstract
Aim
Appendix neoplasms are rare. Half are neuroendocrine tumours (NET). Incidence of NET is 0.4 per hundred thousand and of low-grade appendix mucinous neoplasm (LAMN) is 0.2-0.3 per hundred thousand. Most are diagnosed incidentally on appendicectomy specimens. The aim of this study was to ascertain the incidence of appendix neoplasms managed in a tertiary referral centre and to ascertain compliance with international guidelines.
Method
A prospectively maintained gastrointestinal oncology database was interrogated over a six-year period (July 2016-July 2022). Histologically confirmed primary appendix neoplasms were included. Data collected included patient demographics, clinical presentation, management and follow up (median 38 months). Histopathological staging was according to the AJCC 8th edition. Institutional review board permission was not required.
Results
Incidence of appendix neoplasm over the study period is 1.3% (16/1259). These included 8 NET, 5 LAMNs, 2 invasive adenocarcinoma and 1 adenocarcinoid. A majority were managed with definitive appendicectomy. One patient underwent right hemicolectomy following discussion at tumour board meeting. Four patients were enrolled on a surveillance programme. A further four with LAMN underwent appendicectomy only and one had appendicectomy and partial caecectomy. Surveillance was not deemed necessary in any of the LAMN cases.
Conclusions
Incidence of appendix neoplasm in our centre is comparable to that reported in larger series (2%). All cases were discussed at tumour board meeting. Management in all cases was in keeping with current guidelines. While most patients had adequate margin clearance with appendectomy alone, a small number required further surgery and/or surveillance.