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Surgical Extent and Long-term Survival in Appendiceal Adenocarcinoma : A Systematic Review and Meta-analysis

Ramadan, Shaima LU orcid ; Hertervig, Fredrik ; Olsson, Åsa LU and Buchwald, Pamela LU (2026) In In Vivo 40(1). p.17-29
Abstract

BACKGROUND/AIM: Appendiceal adenocarcinomas are rare tumours with aggressive traits, most often diagnosed incidentally after routine appendectomy. Survival rates vary greatly between the different subgroups, and adenocarcinoma has the worst prognosis. Surgery is the only curative treatment, however, the long-term benefit of extended surgical resections over appendectomy has not been established. This study aimed to investigate survival outcomes in patients with appendiceal adenocarcinoma that undergo appendectomy versus right hemicolectomy (RHC).

MATERIALS AND METHODS: This study involved a systematic literature search in databases PubMed, Embase and Cochrane Library using the COVIDENCE software. Cohort studies reporting survival... (More)

BACKGROUND/AIM: Appendiceal adenocarcinomas are rare tumours with aggressive traits, most often diagnosed incidentally after routine appendectomy. Survival rates vary greatly between the different subgroups, and adenocarcinoma has the worst prognosis. Surgery is the only curative treatment, however, the long-term benefit of extended surgical resections over appendectomy has not been established. This study aimed to investigate survival outcomes in patients with appendiceal adenocarcinoma that undergo appendectomy versus right hemicolectomy (RHC).

MATERIALS AND METHODS: This study involved a systematic literature search in databases PubMed, Embase and Cochrane Library using the COVIDENCE software. Cohort studies reporting survival outcomes for patients with non-metastasised appendiceal adenocarcinoma undergoing appendectomy versus RHC were included. A random-effects model was used to pool hazard ratios (HRs) in the meta-analysis performed in Review Manager. The ROBINS-I V2 tool was used for risk of bias assessment.

RESULTS: A total of nine retrospective registry-based cohort studies were identified. Seven studies, with a total of 17,802 patients, reported overall survival (OS) from multivariable Cox- regression analysis. The pooled effect of adjusted HRs demonstrated increased OS [random-effects HR=0.69, 95% confidence interval (CI)=0.58-0.83] for patients undergoing RHC, with similar results in the sensitivity analysis excluding potential overlapping data (random-effects HR=0.70, 95% CI=0.51-0.96). No significant difference in OS was found in studies reporting subgroup analysis for well-differentiated adenocarcinoma.

CONCLUSION: This systematic review highlights the complexity of surgical treatment guidelines in appendiceal adenocarcinoma. The findings suggest a survival advantage for RHC compared to appendectomy. In well differentiated early-stage adenocarcinoma, appendectomy may be sufficient, although this may not apply to all subgroups.

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Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Appendiceal Neoplasms/surgery, Adenocarcinoma/surgery, Appendectomy/methods, Prognosis, Colectomy/methods, Treatment Outcome
in
In Vivo
volume
40
issue
1
pages
17 - 29
publisher
International Institute of Anticancer Research
external identifiers
  • pmid:41482399
ISSN
0258-851X
DOI
10.21873/invivo.14169
language
English
LU publication?
yes
additional info
Copyright © 2026, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
id
1a1ea91a-0527-4700-9399-1ff7f6821a80
date added to LUP
2026-01-05 20:44:36
date last changed
2026-01-07 13:18:10
@article{1a1ea91a-0527-4700-9399-1ff7f6821a80,
  abstract     = {{<p>BACKGROUND/AIM: Appendiceal adenocarcinomas are rare tumours with aggressive traits, most often diagnosed incidentally after routine appendectomy. Survival rates vary greatly between the different subgroups, and adenocarcinoma has the worst prognosis. Surgery is the only curative treatment, however, the long-term benefit of extended surgical resections over appendectomy has not been established. This study aimed to investigate survival outcomes in patients with appendiceal adenocarcinoma that undergo appendectomy versus right hemicolectomy (RHC).</p><p>MATERIALS AND METHODS: This study involved a systematic literature search in databases PubMed, Embase and Cochrane Library using the COVIDENCE software. Cohort studies reporting survival outcomes for patients with non-metastasised appendiceal adenocarcinoma undergoing appendectomy versus RHC were included. A random-effects model was used to pool hazard ratios (HRs) in the meta-analysis performed in Review Manager. The ROBINS-I V2 tool was used for risk of bias assessment.</p><p>RESULTS: A total of nine retrospective registry-based cohort studies were identified. Seven studies, with a total of 17,802 patients, reported overall survival (OS) from multivariable Cox- regression analysis. The pooled effect of adjusted HRs demonstrated increased OS [random-effects HR=0.69, 95% confidence interval (CI)=0.58-0.83] for patients undergoing RHC, with similar results in the sensitivity analysis excluding potential overlapping data (random-effects HR=0.70, 95% CI=0.51-0.96). No significant difference in OS was found in studies reporting subgroup analysis for well-differentiated adenocarcinoma.</p><p>CONCLUSION: This systematic review highlights the complexity of surgical treatment guidelines in appendiceal adenocarcinoma. The findings suggest a survival advantage for RHC compared to appendectomy. In well differentiated early-stage adenocarcinoma, appendectomy may be sufficient, although this may not apply to all subgroups.</p>}},
  author       = {{Ramadan, Shaima and Hertervig, Fredrik and Olsson, Åsa and Buchwald, Pamela}},
  issn         = {{0258-851X}},
  keywords     = {{Humans; Appendiceal Neoplasms/surgery; Adenocarcinoma/surgery; Appendectomy/methods; Prognosis; Colectomy/methods; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{17--29}},
  publisher    = {{International Institute of Anticancer Research}},
  series       = {{In Vivo}},
  title        = {{Surgical Extent and Long-term Survival in Appendiceal Adenocarcinoma : A Systematic Review and Meta-analysis}},
  url          = {{http://dx.doi.org/10.21873/invivo.14169}},
  doi          = {{10.21873/invivo.14169}},
  volume       = {{40}},
  year         = {{2026}},
}