Appendix cancer surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Surgery is the mainstay of treatment for appendix cancer. The feasibility as well as determining the appropriate plan of surgery depends on the stage of appendix cancer at diagnosis.

Surgery

• Surgery is the mainstay of treatment for appendix cancer.
• The feasibility as well as determining the appropriate plan of surgery depends on the stage of appendix cancer at diagnosis.
• Carcinoid tumors are generally treated with appendectomy, right hemicolectomy and surrounding lymph nodes dissection.
• Non-carcinoid tumors are candied for tumor debulking surgery; in addition to right hemicolectomy and tumor dissection (also called cytoreductive surgery), gallbladder, as well ovaries and uterus in female patients might be excised. Tumor debulking surgery might accompanied by hyperthermic intraperitoneal chemotherapy (HIPEC), specially in high stage cases with peritoneal seeding as well as in patients with pseudomyxoma peritonei.

• Approach to mucinous adenocarcinoma of the appendix

• First determine weather the tumor is ruptured or not?<math>\blacktriangledown</math>

• If not ruptured determine the grade <math>\blacktriangledown</math>

• Right hemicolectomy with lymph node dissection is the appropriate approach for high grade tumors
• In low grade tumors appendectomy would be enough

• If the tumor is ruptured <math>\blacktriangledown</math>

• In gross peritoneal disease imaging to evaluate eligibility for complete cytoreduction is warranted, and if it was feasable cytoreduction and HIPEC is recommended.
• In microscopic rupture the tumor grade plays the determinant role:<math>\blacktriangledown</math>

• laporoscopic evaluation and resection of the residual tumor is recommended for low grade tumors.
• High grade tumors should be treated with laparotomy, residual tumor removal, right hemicolectomy, omentectomy, right lower quadrant peritonectomy, plus bilateral oophorectomy in female patients, followed by HIPEC.