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)
312133
Colonoscopy should be performed in patients with confirmed or suspected appendiceal neoplasms. (1C)
312133
Appendectomy should be performed if a grossly abnormal appendix is encountered during an unrelated abdominal operation. (1C)
312133
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)
312133
NET-specific imaging is not required for all patients with appendiceal NETs. (2B)
312133
Biochemical testing should be performed in patients with localized or metastatic appendiceal NETs to establish baseline measures for future surveillance and disease monitoring. (2B)
312133
Extent of surgical resection of appendiceal NETs is determined by tumor size and histologic features. (1C)
312133
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)
312133
APPENDICEAL MUCINOUS NEOPLASMS AND ADENOCARCINOMA
Tumor markers typically should be assessed on diagnosis of appendiceal epithelial neoplasms and routinely followed after resection. (2C)
312133
Cross-sectional imaging with CT or MRI should be performed on diagnosis of appendiceal epithelial neoplasms and routinely followed after resection. (1C)
312133
Peritoneal cytology has minimal impact on the management of patients with appendiceal tumors and is not recommended as routine practice. (2C)
312133
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)
312133
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)
312133
CRS is indicated in selected patients with appendiceal neoplasms and evidence of peritoneal involvement. (1B)
312133
In selected patients with appendiceal epithelial neoplasms, intraperitoneal chemotherapy may offer additional benefit for reducing peritoneal disease recurrence compared with CRS alone. (1B)
312133
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)
312133
Title
Management of Appendiceal Neoplasms
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
December 1, 2019
Last Updated Month/Year
July 5, 2023
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