Adenocarcinoid of the Appendix: Is Right Hemicolectomy Necessary? A Meta-analysis of Retrospective Chart Reviews

Abstract

The purpose of this study was to determine the efficacy of simple appendectomy versus right hemicolectomy in the treatment of localized adenocarcinoid of the appendix. A literature review of retrospective chart reviews from 1966 to March 1, 2003, was performed. Outcomes of retrospective chart reviews were assessed on the basis of treatment modality. Meta-analysis of studies by determining odds ratios for appendectomy versus extended resection using the Hunter-Schmidt meta-analytic method was performed. One hundred patients from 13 studies met inclusion criteria. Seven per cent failure rate with appendectomy alone and 10 per cent with extended resection were observed [OR 1.9 (0.6–5.8); association χ2 1.15, 1 df, P = 0.28]. Our data supports the use of appendectomy alone in localized cases of adenocarcinoid of the appendix provided there is no cecal involvement and the tumor's histology is low grade.

Surgical Treatment of Appendiceal Adenocarcinoid (Goblet Cell Carcinoid)

“…In accordance with these data, our results support the idea that appendectomy alone is associated with good results in patients with a small (< 1 cm) adenocarcinoid not expanding beyond the appendix and a low mitosis rate. By contrast, adenocarcinoids > 1 cm in size, with a mitosis count of > 2/10 HPF, and/or spreading beyond appendiceal adventitia are probably better treated with an extended resection (i.e., right colectomy in accordance with Varisco et al [7]. Although experience with adjuvant treatment of adenocarcinoid is sparse, two recent reports have shown encouraging results for peritoneal carcinomatosis treatment: cytoreduction and intraperitoneal chemotherapy [3] or for metastatic cases Folfox chemotherapy [23].…”

“…[4][5][6] Adenocarcinoid have a propensity for ovarian metastasis and peritoneal carcinomatosis. 3,7 Recently, the natural history of peritoneal carcinomatosis from appendiceal adenocarci-noid has been shown to be similar to that of adenocarcinoma. 3 Clinically, adenocarcinoid is a relatively indolent neoplasm not associated with carcinoid syndrome.…”

“…7 There is still debates as to whether they should be treated by appendectomy alone, as for most carcinoids, or it right hemicolectomy is indicated as for appendiceal adenocarcinoma. 7,11 Moreover, no definitive staging system has been validated for appendiceal adenocarcinoid, and the value of the TNM staging system has never been tested. The malignant potential of appendiceal adenocarcinoids is evaluated similar to appendiceal carcinoids: tumor size and mitosis rate.…”

“…[4][5][6] In particular, adenocarcinoid has a propensity for ovarian metastasis and principally peritoneal carcinomatosis. 3,7 Debates continue as to whether the appendiceal adenocarcinoid should be treated by appendectomy alone, as for most carcinoids, or if right hemicolectomy is indicated as for the appendiceal adenocarcinoma. 7 This study was undertaken to review the long-term results of surgical treatment of appendiceal adenocarcinoids and evaluate the role of appendectomy alone in selected cases.…”

“…The aggressiveness of the adenocarcinoid is still unclear [3] but is probably more aggressive than the carcinoid and less so than colorectal adenocarcinoma [4–6]. In particular, adenocarcinoid has a propensity for ovarian metastasis and principally peritoneal carcinomatosis [3, 7].…”