Neoplastic Appendicitis - Abstract
Background: Appendiceal cancer as a cause of appendicitis is a rare event
occurring in approximately 1.0% of all cases of appendicitis. Nevertheless, treatment
of appendiceal cancer as appendicitis may have an adverse outcome for the patient,
even iatrogenically converting a contained malignant process into a disseminated
disease that will have a lethal outcome.
Methods: Staging of appendiceal cancer and the shortcomings of the TNM
are reviewed. The new standard of management for a contained or disseminated
appendiceal neoplasm is presented.
Results: The condition of the wall of the appendix, both before and after the
resection of an appendiceal neoplasm is crucial in optimal treatment planning. The
histologic grade of indolent versus aggressive disease and the extent of disease
are important prognostic indicators. Cytoreductive surgery (CRS) and hyperthermic
perioperative chemotherapy (HIPEC) are now standard of care if peritoneal
dissemination has occurred. Judgments regarding the need for right colon resection in
patients with low-grade histology have changed.
Conclusions: Cancer as a cause of appendicitis is rare but since appendicitis is
such a common disease process, the general surgeon and surgical oncologist must be
prepared to optimally treat an appendiceal neoplasm. New paradigms for patient
management have, in the recent past, become a standard of care.