Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study

Cédric Nesti¹, Konstantin Bräutigam², Marta Benavent³, Laura Bernal³, Hessa Boharoon⁴, Johan Botling⁵, Antonin Bouroumeau⁶, Iva Brcic⁷, Maximilian Brunner⁸, Guillaume Cadiot⁹, Maria Camara¹⁰, Emanuel Christ¹¹, Thomas Clerici¹², Ashley K Clift¹³, Hamish Clouston¹⁴, Lorenzo Cobianchi¹⁵, Jarosław B Ćwikła¹⁶, Kosmas Daskalakis¹⁷, Andrea Frilling¹³, Rocio Garcia-Carbonero¹⁸, Simona Grozinsky-Glasberg¹⁹, Jorge Hernando²⁰, Valérie Hervieu²¹, Johannes Hofland²², Pernille Holmager²³, Frediano Inzani²⁴, Henning Jann²⁵, Paula Jimenez-Fonseca²⁶, Enes Kaçmaz²⁷, Daniel Kaemmerer²⁸, Gregory Kaltsas¹⁷, Branislav Klimacek²⁹, Ulrich Knigge³⁰, Agnieszka Kolasińska-Ćwikła³¹, Walter Kolb¹², Beata Kos-Kudła³², Catarina Alisa Kunze³³, Stefania Landolfi³⁴, Stefano La Rosa³⁵, Carlos López López³⁶, Kerstin Lorenz³⁷, Maurice Matter³⁸, Peter Mazal³⁹, Claudia Mestre-Alagarda⁴⁰, Patricia Morales Del Burgo⁴¹, Els J M Nieveen van Dijkum²⁷, Kira Oleinikov¹⁹, Lorenzo A Orci⁴², Francesco Panzuto⁴³, Marianne Pavel⁴⁴, Marine Perrier⁹, Henrik Mikael Reims⁴⁵, Guido Rindi⁴⁶, Anja Rinke⁴⁷, Maria Rinzivillo⁴⁸, Xavier Sagaert⁴⁹, Ilker Satiroglu³⁷, Andreas Selberherr⁵⁰, Alexander R Siebenhüner⁵¹, Margot E T Tesselaar⁵², Michael J Thalhammer⁵³, Espen Thiis-Evensen⁵⁴, Christos Toumpanakis⁴, Timon Vandamme⁵⁵, José G van den Berg⁵⁶, Alessandro Vanoli⁵⁷, Marie-Louise F van Velthuysen⁵⁸, Chris Verslype⁵⁹, Stephan A Vorburger⁶⁰, Alessandro Lugli², John Ramage⁶¹, Marcel Zwahlen⁶², Aurel Perren², Reto M Kaderli⁶³

Affiliations

¹ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Institute of Pathology, University of Bern, Bern, Switzerland.
³ Department of Medical Oncology, University Hospital Virgen del Rocío, Instituto de Biomedicina De Sevilla, Seville, Spain.
⁴ Neuroendocrine Tumour Unit-ENETS Centre of Excellence, Royal Free Hospital London, London, UK.
⁵ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
⁶ Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
⁷ Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
⁸ Department of Surgery, University Hospital of Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
⁹ Service d'Hépato-gastroentérologie et d'Oncologie Digestive, Université Reims Champagne Ardenne, CHU de Reims, Reims, France.
¹⁰ Pathology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
¹¹ Department of Endocrinology, Diabetology and Metabolism, ENETS Center of Excellence, University Hospital of Basel, Basel, Switzerland.
¹² Klinik für Allgemein-, Viszeral-, Endokrin- und Transplantationschirurgie, Kantonsspital St Gallen, St Gallen, Switzerland.
¹³ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁴ Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
¹⁵ Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of General Surgery, IRCCS Policlinico San Matteo Fondazione, Pavia, Italy.
¹⁶ Indywidualna Specjalistyczna Praktyka Lekarska, Warsaw, Poland.
¹⁷ 1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian University of Athens, ENETS Center of Excellence, Athens, Greece.
¹⁸ Oncology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
¹⁹ Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
²⁰ Medical Oncology Department, Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology, Barcelona, Spain.
²¹ Hospices Civils de Lyon, HEH, Lyon, France.
²² Department of Internal Medicine, Section of Endocrinology ENETS Center of Excellence and Erasmus Cancer Institute, Erasmus MC, Rotterdam, Netherlands.
²³ ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
²⁴ General Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy.
²⁵ Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany.
²⁶ Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
²⁷ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
²⁸ Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
²⁹ Department of Surgery, Endocrine Surgical Unit, Uppsala University, Uppsala, Sweden.
³⁰ ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³¹ The Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
³² Department of Endocrinology and Neuroendocrine Neoplasms and Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland.
³³ Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³⁴ Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
³⁵ Institute of Pathology, Department of Laboratory Medicine and Pathology, University of Lausanne, Lausanne, Switzerland; Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
³⁶ Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
³⁷ Department of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Halle, Germany.
³⁸ Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
³⁹ Department of Clinical Pathology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
⁴⁰ Histopathology, Institute of Liver Studies, King's College Hospital, London, UK.
⁴¹ Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain.
⁴² Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
⁴³ Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
⁴⁴ Department of Medicine 1, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
⁴⁵ Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁴⁶ Unit of Head and Neck, Lung, and Endocrine Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy; Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴⁷ Department of Gastroenterology and Endocrinology, UKGM, Marburg, Germany; Philipps University Marburg, Marburg, Germany.
⁴⁸ Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
⁴⁹ Translational Cell & Tissue Research, KU Leuven, Leuven, Belgium.
⁵⁰ Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
⁵¹ Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich und Universität Zürich, Zurich, Switzerland; Departement Medizinische Onkologie, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
⁵² Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁵³ Department of Surgery, Division of Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.
⁵⁴ Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁵⁵ University Hospital Antwerp, Edegem, Belgium.
⁵⁶ Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁵⁷ Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Unit of Anatomic Pathology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
⁵⁸ Department of Pathology, Erasmus MC, Rotterdam, Netherlands.
⁵⁹ Clinical Digestive Oncology, University Hospitals Leuven, Belgium.
⁶⁰ Surgical Department, Teaching Hospitals Emmental, Burgdorf, Switzerland.
⁶¹ University of Winchester, Winchester, UK; Hampshire Hospital, Basingstoke, UK.
⁶² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁶³ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: reto.kaderli@insel.ch.

PMID: 36640790
DOI: 10.1016/S1470-2045(22)00750-1

Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study

Cédric Nesti et al. Lancet Oncol. 2023 Feb.

. 2023 Feb;24(2):187-194.

doi: 10.1016/S1470-2045(22)00750-1. Epub 2023 Jan 11.

Authors

Affiliations

¹ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Institute of Pathology, University of Bern, Bern, Switzerland.
³ Department of Medical Oncology, University Hospital Virgen del Rocío, Instituto de Biomedicina De Sevilla, Seville, Spain.
⁴ Neuroendocrine Tumour Unit-ENETS Centre of Excellence, Royal Free Hospital London, London, UK.
⁵ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
⁶ Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
⁷ Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
⁸ Department of Surgery, University Hospital of Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
⁹ Service d'Hépato-gastroentérologie et d'Oncologie Digestive, Université Reims Champagne Ardenne, CHU de Reims, Reims, France.
¹⁰ Pathology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
¹¹ Department of Endocrinology, Diabetology and Metabolism, ENETS Center of Excellence, University Hospital of Basel, Basel, Switzerland.
¹² Klinik für Allgemein-, Viszeral-, Endokrin- und Transplantationschirurgie, Kantonsspital St Gallen, St Gallen, Switzerland.
¹³ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁴ Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
¹⁵ Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of General Surgery, IRCCS Policlinico San Matteo Fondazione, Pavia, Italy.
¹⁶ Indywidualna Specjalistyczna Praktyka Lekarska, Warsaw, Poland.
¹⁷ 1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian University of Athens, ENETS Center of Excellence, Athens, Greece.
¹⁸ Oncology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
¹⁹ Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
²⁰ Medical Oncology Department, Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology, Barcelona, Spain.
²¹ Hospices Civils de Lyon, HEH, Lyon, France.
²² Department of Internal Medicine, Section of Endocrinology ENETS Center of Excellence and Erasmus Cancer Institute, Erasmus MC, Rotterdam, Netherlands.
²³ ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
²⁴ General Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy.
²⁵ Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany.
²⁶ Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
²⁷ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
²⁸ Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
²⁹ Department of Surgery, Endocrine Surgical Unit, Uppsala University, Uppsala, Sweden.
³⁰ ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³¹ The Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
³² Department of Endocrinology and Neuroendocrine Neoplasms and Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland.
³³ Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³⁴ Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
³⁵ Institute of Pathology, Department of Laboratory Medicine and Pathology, University of Lausanne, Lausanne, Switzerland; Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
³⁶ Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
³⁷ Department of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Halle, Germany.
³⁸ Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
³⁹ Department of Clinical Pathology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
⁴⁰ Histopathology, Institute of Liver Studies, King's College Hospital, London, UK.
⁴¹ Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain.
⁴² Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
⁴³ Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
⁴⁴ Department of Medicine 1, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
⁴⁵ Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁴⁶ Unit of Head and Neck, Lung, and Endocrine Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy; Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴⁷ Department of Gastroenterology and Endocrinology, UKGM, Marburg, Germany; Philipps University Marburg, Marburg, Germany.
⁴⁸ Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
⁴⁹ Translational Cell & Tissue Research, KU Leuven, Leuven, Belgium.
⁵⁰ Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
⁵¹ Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich und Universität Zürich, Zurich, Switzerland; Departement Medizinische Onkologie, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
⁵² Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁵³ Department of Surgery, Division of Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.
⁵⁴ Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁵⁵ University Hospital Antwerp, Edegem, Belgium.
⁵⁶ Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁵⁷ Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Unit of Anatomic Pathology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
⁵⁸ Department of Pathology, Erasmus MC, Rotterdam, Netherlands.
⁵⁹ Clinical Digestive Oncology, University Hospitals Leuven, Belgium.
⁶⁰ Surgical Department, Teaching Hospitals Emmental, Burgdorf, Switzerland.
⁶¹ University of Winchester, Winchester, UK; Hampshire Hospital, Basingstoke, UK.
⁶² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁶³ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: reto.kaderli@insel.ch.

PMID: 36640790
DOI: 10.1016/S1470-2045(22)00750-1

Abstract

Background: Awareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1-2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1-2 cm in size in patients with or without right-sided hemicolectomy.

Methods: In this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1-2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693.

Findings: 282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1-2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0-15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 -21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36-2·17]; p=0·71).

Interpretation: This study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1-2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort.

Funding: Swiss Cancer Research foundation.

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Conflict of interest statement

Declaration of interests MBe reports funding from Novartis, Pfizer, and Ipsen; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from Novartis, Pfizer, Ipsen, and Advanced Accelerator Applications (AAA); support for attending meetings or travel from Novartis, Pfizer, and Ipsen; and participation on data safety monitoring board or advisory boards from Pfizer and AAA. IB reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from Bristol Myers Squibb (BMS) and Bayer Vital and support for attending meetings or travel for European Musculo-Skeletal Oncology Society 2022 conference from PharmaMar. RG-C reports funding of investigator-initiated clinical trials from Pfizer, BMS, and MSD, and an real-world data project from Servier; consulting fees from AAA/Novartis, Advanz Pharma, Amgen, Bayer, BMS, Boehringer (Ingelheim), Esteve, Hutchmed, Ipsen, Merck, Midatech Pharma, MSD, PharmaMar, and Pierre Fabre; and payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from Roche. GC reports grants or contracts from AAA; consulting fees from AAA; payments or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from AAA, Ipsen, and Keocyt; and support for attending meetings or travel from AAA, Ipsen, and Keocyt. MPa reports payments for advisory boards or lectures from AAA and Novartis; payments for advisory boards, consultancy, or lectures from Ipsen; payment for lectures from Boehringer Ingelheim, MSD, Lilly, and Recordati; payment for advisory boards from Riemser; payment for services (radiological review of phase 3 study) from Hutchmed; payment for travel for participation in study steering committee meeting from Rayzebio; payment to institution from Crinetics and AAA; and unpaid roles as ENETS vice president, European Society for Medical Oncology (ESMO) Education Committee, ESMO scientific steering committee NET track, advisor on the International Neuroendocrine Cancer Alliance board, and advisor for German patient support group. GR reports payments for speaker bureaus from AAA. AR reports being an ENETS Advisory Board member. TV reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from Ipsen; support for attending meetings or travel from Ipsen; and an unpaid position as secretary in the Dutch Belgian Neuroendocrine Tumor Society. All other authors declare no competing interests.

Comment in

Are hemicolectomies justified for appendiceal neuroendocrine tumours smaller than 2 cm?
Strosberg JR, Al-Toubah T. Strosberg JR, et al. Lancet Oncol. 2023 Feb;24(2):121-122. doi: 10.1016/S1470-2045(22)00764-1. Epub 2023 Jan 11. Lancet Oncol. 2023. PMID: 36640791 No abstract available.
Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1-2 cm.
Lamberti G, Andrini E, Ricci C, Campana D. Lamberti G, et al. Lancet Oncol. 2023 May;24(5):e187. doi: 10.1016/S1470-2045(23)00059-1. Lancet Oncol. 2023. PMID: 37142375 No abstract available.
Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1-2 cm.
Aktas MK, Aytac E, Yildiz I, Ozer L. Aktas MK, et al. Lancet Oncol. 2023 May;24(5):e188. doi: 10.1016/S1470-2045(23)00098-0. Lancet Oncol. 2023. PMID: 37142376 No abstract available.
Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1-2 cm.
Halfdanarson TR, Grotz TE, Gudmundsdottir H, Cleary SP. Halfdanarson TR, et al. Lancet Oncol. 2023 May;24(5):e189. doi: 10.1016/S1470-2045(23)00122-5. Lancet Oncol. 2023. PMID: 37142377 No abstract available.
Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1-2 cm - Authors' reply.
Kaderli RM, Nesti C, Bräutigam K, Zwahlen M, Perren A. Kaderli RM, et al. Lancet Oncol. 2023 May;24(5):e190-e191. doi: 10.1016/S1470-2045(23)00114-6. Lancet Oncol. 2023. PMID: 37142378 No abstract available.
Hemicolectomy versus appendectomy alone for appendiceal neuroendocrine tumours between 1-2 cm in size-are we overtreating?
Bachiri S, van Amstel P, Koppen IJN, van der Weide MC, Raphael MF, Gorter RR. Bachiri S, et al. Transl Cancer Res. 2023 Sep 30;12(9):2420-2424. doi: 10.21037/tcr-23-655. Epub 2023 Aug 17. Transl Cancer Res. 2023. PMID: 37859747 Free PMC article. No abstract available.
Treatment of appendiceal neuroendocrine tumour: a controversial treatment for a misunderstood neoplasm in a mysterious organ.
Petroianu A. Petroianu A. Transl Cancer Res. 2024 Aug 31;13(8):3940-3943. doi: 10.21037/tcr-23-510. Epub 2024 Aug 23. Transl Cancer Res. 2024. PMID: 39262471 Free PMC article. No abstract available.

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Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study

Affiliations

Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study

Authors

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Abstract

Conflict of interest statement

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