Data Show Underutilization of Appendectomy in Appendix Cancer Population

Muhammad Talha Waheed, MD, coauthored a study that ultimately found that only a little more than a quarter—26%—of patients with appendiceal cancer received appendectomy alone.

Waheed, a postdoctoral research fellow at City of Hope Comprehensive Cancer Center in Duarte, California, believes this is a “concern” because there are guidelines that do recommend a right hemicolectomy for appendiceal carcinomas. While conducting the study, investigators hypothesized this gap may have been due to subgroups of patients with greater comorbidities. They ultimately found that was not the case and that there was an “underutilization” of appendectomy, particularly at Commission on Cancer–accredited hospitals.

CancerNetwork® spoke with Waheed before the 2025 Society of Surgical Oncology Annual Meeting about a poster he presented on the differences in outcomes between the 2 approaches in patients with appendiceal cancer.

He gave potential reasons why this number for appendectomy use was low, such as a loss of follow-up, out-of-state procedures, or the lack of guidelines, but emphasized that “we should advocate for these patients to get a definite resection if needed.”

Transcript:

[The underutilization of right colectomy] is a key finding of the paper. This does not take away from the results because the main question of our paper remains, “When patients get a right colectomy, what is the optimal sequence of the resection?”

This underutilization of right colectomy after appendectomy is a key finding. It’s a cause of concern because although some large databases do support appendectomy alone in certain clinical scenarios for appendiceal adenocarcinomas—for example, in the setting of appendiceal adenocarcinomas or well-differentiated mucinous appendiceal carcinomas— the Chicago Consensus Guidelines or the American Society of Colon and Rectal Surgeons guidelines do recommend a right hemicolectomy for appendiceal adenocarcinomas. That [prompted] us to ask if there is a risk vs benefit question that is going on. Do these patients have more comorbidities or sickness? Is that why these patients did not undergo colectomy? When we looked at it, [more] patients underwent appendectomy alone and had no or minimal reported comorbidities. This underutilization remained very high in patients treated at [Commission on Cancer–accredited] hospitals.

We speculate that this could be because of lack of consensus guidelines for appendiceal adenocarcinomas up until recently. It could be because of a loss of follow-up, or maybe these patients were traveling out of state, got their first resection, and went back, traveled, and got their resection out of state. We were not able to capture that. Regardless, this should be explored further. We should advocate for these patients to get a definite resection if needed.

Reference

Waheed MT, Malik I, Ituarte PHG, et al. Upfront colectomy vs. initial appendectomy followed by completion colectomy for appendiceal cancer: comparison of outcomes. Presented at: 2025 Society of Surgical Oncology Annual Meeting; March 27-29, 2025; Tampa, FL.