Abstract :
[en] AIM: To report the experience of a tertiary center in the management of appendiceal tumor.
METHODS: We retrospectively reviewed our experience from 2010 to 2021, including 102 appendiceal tumors amongst 3,432 appendicectomies. Demographic data, clinical presentation, histopathology, operative reports, treatment and outcome were retrieved from the medical charts.
RESULTS: Among the 102 tumors, 41 appendiceal neuroendocrine tumors (NET) (40%), 29 low grade mucinous neoplasm (28%) and 36 adenocarcinoma (35%) were identified. Goblet cells were described in 7% of NET and in 22% of adenocarcinoma. 18 cases of pseudomyxoma peritonei were included. The most frequent clinical presentation was acute appendicitis with tumor diagnosis on appendiceal resection specimen, but in 28% of cases, the diagnosis of appendiceal tumor was suspected before surgery using medical imaging. Surgery was performed by laparoscopy in 60% of cases, and postoperative course was almost always without or with minor complication (Clavien 0 to 2 in 91% of cases). Three patients with incidental appendiceal tumor died postoperatively (<30 days). Regarding NET patients, revision surgery (6) with right hemicolectomy (n=5) was performed according to the oncology board. None of them suffered from recurrency. Concerning adenocarcinoma, 45% required revision surgery and HIPEC was performed in 34%. Adjuvant therapy, exclusively by FOLFOX, was performed in 34% of adenocarcinoma. Despite aggressive management, 22% suffered from recurrency during the follow-up. The 1-year and 5-y survival rates were 91% and 45%, respectively in the adenocarcinoma series.
CONCLUSION: Appendiceal tumors are not rare and they often presented as acute appendicitis. Appendiceal NET are less invasive and simple follow-up is recommended in the majority of the cases, except for locally advanced cases (T3-T4) where surgical revision is needed. Appendiceal adenocarcinoma is a particularly recurrent tumor despite aggressive multidisciplinary management.
