Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix
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Swathi R Raikot, Donald Dean Potter Jr , Courtney N Day. Hallbera Gudmundsdottir, Wendy A Allen-Rhoades, Elizabeth B Habermann, Stephanie F Polites
Abstract
Background: Children continue to undergo right hemicolectomy (RHC) for neuroendocrine tumors (NET) of the appendix based on adult guidelines. Appendectomy alone is recommended for the pediatric population; however, there are no data on safety of this approach in the setting of positive margins. This study aimed to determine the association between tumor characteristics and survival in a national cohort, hypothesizing that survival would be excellent despite high-risk features including positive margins on appendectomy.
Study design: Patients aged ≤ 18 years with NET of the appendix were identified in the National Cancer Database from 2004 to 2022 using ICD-O-3 codes. Characteristics of patients who underwent definitive appendectomy vs RHC were compared using Chi-square tests. Five-year survival was determined for appendectomy patients with and without high-risk size, margin, and lymph node (LN) features.
Results: Of 1,339 patients, 1,156 (86%) underwent appendectomy and 183 (14%) RHC. Median age in both groups was 15 (13, 17) years. Patients who underwent RHC had larger tumors (24% vs 4% >2 cm, p<.001), more lymphovascular invasion (31% vs 10%, p<.001), and were more likely to undergo LN assessment (82% vs 10%, p<.001) with a higher LN positivity rate (31% vs 16%, p=.006). There was no difference in margins status (p=0.76). The 5- and 10-year survival was excellent regardless of tumor characteristics for patients overall (99.9% and 99.4%, respectively) and for those who underwent definitive appendectomy (99.9% and 99.2%).
Conclusion: These data further support appendectomy as definitive management for children with appendiceal NET. Additional resection does not confer a survival benefit even in the setting of positive margins.
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What if I told you kids with appendix tumors might not need the big surgery that doctors have been doing for decades? I'm Lizzie Lee from Cincinnati Children's and this is an article you should know about. Traditionally, kids with neuroendocrine appendix tumors have been treated the same way as adults, with a right hemicolectomy. But do they really need this surgery? This new national study looked at over 1,300 kids and found something surprising. Even when the tumors were larger or had positive margins, the survival rates were almost perfect, like 99%, whether they just had an appendectomy or the bigger colectomy surgery. So the big takeaway, for kids, appendectomy alone is not only enough, it's safe, effective and avoids putting them through a much bigger operation for no added benefit. Let us know what you think in the comments below and stay tuned for more articles that you should know about.