TY - JOUR
T1 - Surgical Extent and Long-term Survival in Appendiceal Adenocarcinoma
T2 - A Systematic Review and Meta-analysis
AU - Ramadan, Shaima
AU - Hertervig, Fredrik
AU - Olsson, Åsa
AU - Buchwald, Pamela
N1 - Publisher Copyright:
© 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
PY - 2026/1
Y1 - 2026/1
N2 - 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.
AB - 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.
KW - appendectomy
KW - appendiceal adenocarcinoma
KW - Appendiceal malignancy
KW - hemicolectomy
KW - review
KW - survival
KW - Prognosis
KW - Humans
KW - Treatment Outcome
KW - Colectomy/methods
KW - Adenocarcinoma/surgery
KW - Appendiceal Neoplasms/surgery
KW - Appendectomy/methods
UR - http://www.scopus.com/inward/record.url?scp=105026524611&partnerID=8YFLogxK
U2 - 10.21873/invivo.14169
DO - 10.21873/invivo.14169
M3 - Review
C2 - 41482399
AN - SCOPUS:105026524611
SN - 0258-851X
VL - 40
SP - 17
EP - 29
JO - In Vivo
JF - In Vivo
IS - 1
ER -