Management of Appendiceal Neoplasms

Publication Date: December 1, 2019
Last Updated: March 14, 2022

Recommendations

GENERAL CONSIDERATIONS

Patients with appendiceal neoplasms should undergo a complete history and physical examination. (1C)
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Colonoscopy should be performed in patients with confirmed or suspected appendiceal neoplasms. (1C)
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Appendectomy should be performed if a grossly abnormal appendix is encountered during an unrelated abdominal operation. (1C)
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APPENDICEAL NETS

Preoperative assessment of patients with appendiceal neuroendocrine tumors (NETs) should typically include history and physical examination, colonoscopy, and CT or MRI of the chest, abdomen, and pelvis. (1C)
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NET-specific imaging is not required for all patients with appendiceal NETs. (2B)
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Biochemical testing should be performed in patients with localized or metastatic appendiceal NETs to establish baseline measures for future surveillance and disease monitoring. (2B)
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Extent of surgical resection of appendiceal NETs is determined by tumor size and histologic features. (1C)
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Surveillance after resection of appendiceal NETs with curative intent should involve physical examination, serial biochemical testing, and imaging of the chest, abdomen, and pelvis using either CT or MRI. (2C)
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APPENDICEAL MUCINOUS NEOPLASMS AND ADENOCARCINOMA

Tumor markers typically should be assessed on diagnosis of appendiceal epithelial neoplasms and routinely followed after resection. (2C)
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Cross-sectional imaging with CT or MRI should be performed on diagnosis of appendiceal epithelial neoplasms and routinely followed after resection. (1C)
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Peritoneal cytology has minimal impact on the management of patients with appendiceal tumors and is not recommended as routine practice. (2C)
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Patients with low-grade appendiceal neoplasms (LAMNs) with negative margins and no evidence of perforation or peritoneal involvement are safely treated with appendectomy alone. (1B)
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Patients with nonmetastatic adenocarcinoma of the appendix should undergo right hemicolectomy. However, in the setting of peritoneal spread, colectomy may not confer a survival benefit. (1C)
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CRS is indicated in selected patients with appendiceal neoplasms and evidence of peritoneal involvement. (1B)
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In selected patients with appendiceal epithelial neoplasms, intraperitoneal chemotherapy may offer additional benefit for reducing peritoneal disease recurrence compared with CRS alone. (1B)
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Systemic chemotherapy may improve survival in patients with metastatic high-grade appendiceal neoplasms (HAMNs). Benefit from systemic chemotherapy for low-grade lesions with peritoneal spread is questionable. (1C)
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Recommendation Grading

Overview

Title

Management of Appendiceal Neoplasms

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

December 1, 2019

Last Updated Month/Year

January 31, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D001063 - Appendiceal Neoplasms

Keywords

Appendiceal Neoplasms, neoplasms, appendiceal, cystadenoma

Source Citation

Glasgow, Sean C. M.D.1; Gaertner, Wolfgang M.D.2; Stewart, David M.D.3; Davids, Jennifer M.D.4; Alavi, Karim M.D.4; Paquette, Ian M. M.D.5; Steele, Scott R. M.D., M.B.A.6; Feingold, Daniel L. M.D.7 The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms, Diseases of the Colon & Rectum: December 2019 - Volume 62 - Issue 12 - p 1425-1438 doi: 10.1097/DCR.0000000000001530
 

Methodology

Number of Source Documents
153
Literature Search Start Date
January 1, 1997
Literature Search End Date
April 30, 2019