Citations 1
De‐Escalating Surgery for 1–2 cm Appendiceal Neuroendocrine Tumors: A North American Multi‐Center Analysis
Miller, R., Tan, Po Hong, Saleeb, Andrew, Stucky, Chee-Chee, Bagaria, Sanjay P, Gabriel, Emmanuel , Grotz, Travis E. , Wasif, Nabil , Miller, Max , Thompson, Emily , Miller, Richard Max , Thompson, Emily R , Grotz, Travis E , Gabriel, Emmanuel M , Saleeb, Andrew G. , Thompson, Emily R., Fong, Zhi Ven , Bagaria, Sanjay P.
Journal of Surgical Oncology | April 30, 2026 | Volume: 134 | Issue: 1 | Pages: 91-100
ABSTRACT Background and Objectives NCCN guidelines recommend right hemicolectomy (RHC) for appendiceal neuroendocrine tumors (aNETs) > 2 cm and observation for < 1 cm. However, optimal surgical management of 1–2 cm tumors remains controversial. This study compared long‐term survival and recurrence between patients undergoing RHC versus appendectomy (APY) for 1–2 cm aNETs. Methods Patients with pathologically confirmed 1–2 cm aNETs treated at three Mayo Clinic sites (1972–2024) were included. Primary outcomes were recurrence and all‐cause mortality after resection. Associations with lymph node (LN) metastasis were assessed in patients with lymphadenectomy. Results Sixty‐five patients were identified: 29 (45%) underwent APY, 35 (54%) RHC, and one ileocecectomy. Median age at diagnosis was 39 years; 71% were female and 94% white. LN positivity was 15.2% for tumors with nodes examined. Tumor size > 1.5 cm, stage T3/T4, and lymphovascular invasion were not associated with nodal metastasis. No survival differences were observed between APY and RHC. LN positivity did not impact survival. No recurrences occurred during a median follow‐up of 6.25 years (IQR 2.44–12.63). Conclusions Among patients with 1–2 cm aNETs, RHC conferred no survival benefit over APY. Absence of recurrence and the limited prognostic value of nodal disease suggest APY alone may suffice for this population.