ASO Visual Abstract: Omission of Right Hemicolectomy May be Safe for Some Appendiceal Goblet Cell Adenocarcinomas—A Survival Analysis of the National Cancer Database

Goblet Cell Adenocarcinoma of the Appendix: A Systematic Review and Incidence and Survival of 1,225 Cases From an English Cancer Registry

“…In fact, in a retrospective study specifically stratifying by tumour “T” stage, hemicolectomy only conferred a statistically significant survival benefit in T3 and T4 tumours (5-year survival rate 85.4% vs. 82.0%, p = 0.028), with no difference in survival seen in T1 and T2 tumours, regardless of appendicectomy or hemicolectomy (83.6% vs. 87.3% p = 0.176) ( 15 ). Some authors therefore have argued that small (<1 cm), low-grade, and localised tumours with a low proliferation index can be managed with appendicectomy alone ( 8 , 15 , 73 , 103 ); however, in reality, this situation is a rare clinical occurrence ( 109 ). Negative surgical margins have been associated with improved survival in both appendicectomy and hemicolectomy (5-year OS 83.6% vs. 47.2%, p < 0.001) ( 18 ), as has harvesting greater than 12 lymph nodes (HR 0.51, 95% CI: 0.34–0.77, p = 0.0015) ( 12 ).…”

“…The use of adjuvant chemotherapy was investigated in several studies ( 2 , 14 , 15 , 52 , 54 , 56 , 73 , 89 ). Across localised and regional disease, this was given to 14%–17% of patients ( 14 , 89 ).…”

“…Across localised and regional disease, this was given to 14%–17% of patients ( 14 , 89 ). It was more commonly used in younger patients ( 14 ), men, those with higher grade or stage tumours ( 14 , 15 ), and those undergoing hemicolectomy ( 15 ). In one study of 1,083 stage I–III GCA, adjuvant chemotherapy was associated with improved overall survival (HR 0.28, 95% CI: 0.12–0.54, p = 0.002) ( 15 ).…”

“…It was more commonly used in younger patients ( 14 ), men, those with higher grade or stage tumours ( 14 , 15 ), and those undergoing hemicolectomy ( 15 ). In one study of 1,083 stage I–III GCA, adjuvant chemotherapy was associated with improved overall survival (HR 0.28, 95% CI: 0.12–0.54, p = 0.002) ( 15 ). A consistent survival advantage from adjuvant chemotherapy in lymph node-positive ( 14 , 18 ) or stage III ( 2 ) disease was seen in multiple studies.…”

“…Age ( 18 , 40 , 52 ), grade ( 40 , 44 , 90 ), and stage ( 12 , 23 , 40 , 44 , 52 , 55 ) have been identified as independent prognostic factors for survival. Male sex ( 14 ), lymph node metastases ( 14 , 15 , 18 ), and positive surgical margins ( 18 ) have been associated with decreased survival in stage I–III disease on multivariate analyses. The association between tumour size and prognosis was inconsistent ( 18 , 44 ).…”