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

Sep 28, 2026

Appendiceal adenocarcinomas are rare, aggressive tumors often discovered incidentally after appendectomy, with survival varying substantially across subgroups and adenocarcinoma carrying the worst prognosis. Surgery is the only curative option, but the long-term benefit of extended resections versus appendectomy remains uncertain. This systematic review compares survival outcomes for non-metastasised appendiceal adenocarcinoma treated with appendectomy or right hemicolectomy (RHC), pooling adjusted hazard ratios and assessing bias with ROBINS-I V2.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Introduction

Background and clinical rationale

Uncertainty about surgical extent

Materials and Methods

Study design and registration

Selection criteria

doi: 10.21873/invivo.14169 Review Surgical Extent and Long-term Survival in Appendiceal Adenocarcinoma: A Systematic Review and Meta-analysis SHAIMA RAMADAN1,2, FREDRIK HERTERVIG3, ÅSA OLSSON1,2 and PAMELA BUCHWALD1,2 1 Department of Surgery, Colorectal Unit, Skåne University Hospital, Malmö, Sweden; 2 Department of Clinical Sciences, Lund University, Malmö, Sweden; 3Gastro Unit, Surgical Section, Copenhagen University Hospital, Hvidovre, Denmark 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, andadenocarcinoma 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 withappendicealadenocarcinoma 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 appendicealadenocarcinoma 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 appendicealadenocarcinoma. 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. Keywords: Appendiceal malignancy, appendiceal adenocarcinoma, survival, appendectomy, hemicolectomy, review. ✉ Shaima Ramadan, Inga Marie Nilssons gata 47, 205 02 Malmö, Sweden. Tel: +46 704082098, e-mail: shaima.ramadan@ [med.lu.se](med.lu.se) Received October 21, 2025 | Revised November 9, 2025 | Accepted November 13, 2025 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. ©2026 The Author(s) . Anticancer Research is published by the International Institute of Anticancer Research. Introduction Appendiceal neoplasms are rare, with an incidental detection rate of 0.9-1.4% in surgical specimens, following routine appendectomy (1, 2). Despite constituting a small fraction of gastrointestinal malignancies, recent epidemiological studies indicate a rising incidence of appendiceal adenocarcinoma over the past two decades, particularly in Western populations (3-5). This trend has been accompanied by a growing recognition of their biological heterogeneity and complex case management, reflected in recent updates to the WHO classification system and Swedish national treatment guidelines (6-8) . The prognosis for appendiceal adenocarcinoma is generally poor, with five-year survival rates ranging from 27% to 93%, largely depending on the histological subtype, disease stage at diagnosis and completeness of surgical resection (9-11) . Adenocarcinoma of the appendix, in

FAQs

Why is surgical extent important in appendiceal adenocarcinoma?

The review addresses uncertainty about whether extended surgery offers long-term survival benefits over appendectomy. Existing guidelines for localized disease and the optimal extent of resection remain unclear.

What treatments were compared in the study?

The study compared survival outcomes for non-metastasised appendiceal adenocarcinoma patients undergoing appendectomy versus right hemicolectomy (RHC).

What did the pooled results suggest about survival?

The pooled adjusted hazard ratios indicated increased overall survival for patients undergoing RHC compared with appendectomy, with similar findings in sensitivity analyses excluding potential overlapping data.

Sep 28, 2026

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