Management of Incidentally Discovered Appendiceal Malignancies: When to Perform Right Hemicolectomy – Case Series and Literature Review

AIM: Appendiceal neoplasms are rare and are most frequently diagnosed incidentally after appendectomy for suspected acute appendicitis. Their optimal management, particularly the indication for completion right hemicolectomy, remains debated due to the absence of standardized guidelines.CASE PRESENTATION: We present a retrospective case series of four patients who underwent emergency appendectomy for clinical and radiological suspicion of acute appendicitis at Ivrea Hospital between May 2023 and February 2026. Histopathological examination revealed incidental appendiceal malignancies. Clinical, intraoperative, histopathological, and follow-up data were analyzed. A narrative review of the literature was also performed, focusing on current evidence regarding classification, prognostic factors and indications for right hemicolectomy.RESULTS: Among 178 appendectomies performed during the study period, four cases were diagnosed with appendiceal neoplasms: one neuroendocrine tumor (G1), one non-mucinous adenocarcinoma, one goblet cell adenocarcinoma and one mucinous adenocarcinoma. Completion right hemicolectomy was performed in three cases based on histopathological risk factors, while one patient required no further surgical treatment. One patient presented with peritoneal metastatic disease (pT4a pN1a pM1c) and received systemic chemotherapy. At follow-up (6–12 months) no evidence of recurrence was observed.CONCLUSIONS: Incidentally discovered appendiceal neoplasms represent a heterogeneous group of rare tumors requiring individualized management. Completion right hemicolectomy should be considered in selected cases based on histological subtype, stage, and risk factors. Multidisciplinary evaluation is essential to guide optimal treatment and follow-up strategies. This case series supports a selective surgical approach and highlights the importance of careful pathological assessment after appendectomy for acute appendicitis.