Value of prophylactic surgery for appendiceal neuroendocrine neoplasms questioned

Well-differentiated appendiceal neuroendocrine neoplasms (ANENs) is a low-malignant disease, and performing prophylactic surgery should be reconsidered given that the procedure subjects patients to excessive surgery, affects functional health-related quality of life (HRQoL), and increases the risk of diarrhoea, according to a study.

The analysis included 166 patients (mean age, 31 years; 71.2 percent female) with ANENs. Of these, 108 patients had appendectomy alone, while 58 underwent completion prophylactic right hemicolectomy (pRHC) following primary appendectomy (mean time to completion, 116.4 days) over a mean follow-up of 50.9 months.

Tumour size was <20 mm in most patients (89.8 percent) and in the range of 10–20 mm in 71 (42.8 percent). In the pRHC group, 43 patients had tumours ≤20 mm, whereas 39 patients in the appendectomy group had tumours in the gray zone of 10–20 mm.

Of note, pRHC was regarded as an overtreatment in 38 patients (65.5 percent).

On multivariable logistic regression analysis, tumour size >20 mm emerged as the only independent predictor for lymph node (LN) involvement (p=0.002).

There were no reports of death. Furthermore, the 2-, 5-, and 10-year recurrence-free survival rates among the 136 patients subjected to postoperative cross-sectional imaging was high at 98.5 percent, 97.8 percent, and 97.8 percent, respectively.

Global HRQoL was similar in patients with ANEN and age- and sex-matched healthy individuals (median score, 0.83 vs 0.83; p=0.929).

In the patient group, those who underwent pRHC vs appendectomy alone were more likely to have impaired social functioning (p=0.016), diarrhoea (p=0.003), and financial difficulties (p=0.024).