Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Jan;219(1):51–57. doi: 10.1097/00000658-199401000-00009

The natural history of surgically treated primary adenocarcinoma of the appendix.

S S Nitecki 1, B G Wolff 1, R Schlinkert 1, M G Sarr 1
PMCID: PMC1243090  PMID: 8297177

Abstract

OBJECTIVE: The aim of this investigation was to determine the prognostic variables and optimal surgical procedure for patients with adenocarcinoma of the appendix. SUMMARY BACKGROUND DATA: Primary adenocarcinoma of the appendix is a rare malignancy that constitutes less than 0.5% of all gastrointestinal neoplasms. However, the prognostic factors and the preferred surgical procedure and outcome are poorly understood. METHODS: The authors reviewed their institutional experience from 1976 to 1992 in treating 94 consecutive patients with primary adenocarcinoma of the appendix. Patients with carcinoid tumors or those in whom the diagnosis of primary cecal cancer could not be ruled out were excluded from the study. RESULTS: Fifty-two (55%) patients had the mucinous variety, of which 22 had pseudomyxoma peritonei; the other 45% had the colonic and adenocarcinoid types of tumor. The most common presentation was that of acute appendicitis. Interestingly, in no patients was the correct diagnosis made before surgery, and it was entertained intraoperatively in only 30 patients (32%). The cure 5-year survival rate was 55%, but it varied with stage (A, 100%; B, 67%; C, 50%; and D, 6%; p < 0.01) and with grade (I, 68%, and III, 7%; p < 0.01). Patients with the mucinous type had a better prognosis than those with the colonic type (p < 0.01). The survival rate was superior after right hemicolectomy versus appendectomy alone (68% vs. 20%, p < 0.001). Right hemicolectomy performed as a secondary procedure resulted in the upstaging of 38% of the patients' tumors. A second primary malignancy occurred in 33 patients (35%), of which 17 were located in the gastrointestinal tract. CONCLUSIONS: Primary adenocarcinoma of the appendix should be treated by right hemicolectomy, even if it is a secondary procedure. Surveillance for synchronous or metachronous tumors, especially in the gastrointestinal tract, is warranted.

Full text

PDF
51

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson A., Bergdahl L., Boquist L. Primary carcinoma of the appendix. Ann Surg. 1976 Jan;183(1):53–57. doi: 10.1097/00000658-197601000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BROWN H. W., HUSNI E. A. Ruptured adenocarcinoma of the appendix; review of the literature and case presentation. Surgery. 1957 Nov;42(5):953–958. [PubMed] [Google Scholar]
  3. Chang P., Attiyeh F. F. Adenocarcinoma of the appendix. Dis Colon Rectum. 1981 Apr;24(3):176–180. doi: 10.1007/BF02962328. [DOI] [PubMed] [Google Scholar]
  4. Conte C. C., Petrelli N. J., Stulc J., Herrera L., Mittelman A. Adenocarcinoma of the appendix. Surg Gynecol Obstet. 1988 May;166(5):451–453. [PubMed] [Google Scholar]
  5. Edmonds P., Merino M. J., LiVolsi V. A., Duray P. H. Adenocarcinoid (mucinous carcinoid) of the appendix. Gastroenterology. 1984 Feb;86(2):302–309. [PubMed] [Google Scholar]
  6. Edmondson H. T., Jr, Hobbs M. L. Primary adenocarcinoma of the appendix. Am Surg. 1967 Sep;33(9):717–732. [PubMed] [Google Scholar]
  7. FELDMAN S., MANDELBERG A., NICEBERG D. M. Adenocarcinoma of the vermiform appendix; a case presentation and review of the literature. Surgery. 1956 Sep;40(3):560–570. [PubMed] [Google Scholar]
  8. Ferro M., Anthony P. P. Adenocarcinoma of the appendix. Dis Colon Rectum. 1985 Jun;28(6):457–459. doi: 10.1007/BF02560237. [DOI] [PubMed] [Google Scholar]
  9. GUARINO G. B., CHITWOOD E. M., Jr Adenocarcinoma of the appendix: with a review of recent literature. Am J Surg. 1953 Feb;87(2):293–296. doi: 10.1016/0002-9610(54)90559-0. [DOI] [PubMed] [Google Scholar]
  10. Gamble H. A., 2nd Adenocarcinoma of the appendix: an unusual case and review. Dis Colon Rectum. 1976 Oct;19(7):621–625. doi: 10.1007/BF02590980. [DOI] [PubMed] [Google Scholar]
  11. Gilhome R. W., Johnston D. H., Clark J., Kyle J. Primary adenocarcinoma of the vermiform appendix: report of a series of ten cases, and review of the literature. Br J Surg. 1984 Jul;71(7):553–555. doi: 10.1002/bjs.1800710727. [DOI] [PubMed] [Google Scholar]
  12. HESKETH K. T. The management of primary adenocarcinoma of the vermiform appendix. Gut. 1963 Jun;4:158–168. doi: 10.1136/gut.4.2.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Herrera L. O., Ledesma E. J., Natarajan N., Lopez G. E., Tsukada Y., Mittelman A. Metachronous ovarian metastases from adenocarcinoma of the colon and rectum. Surg Gynecol Obstet. 1982 Apr;154(4):531–533. [PubMed] [Google Scholar]
  14. Higa E., Rosai J., Pizzimbono C. A., Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal "mucocele". Cancer. 1973 Dec;32(6):1525–1541. doi: 10.1002/1097-0142(197312)32:6<1525::aid-cncr2820320632>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  15. Hopkins G. B., Tullis R. H., Kristensen K. A. Primary adenocarcinoma of the vermiform appendix: report of seven cases and review of the literature. Dis Colon Rectum. 1973 Mar-Apr;16(2):140–144. doi: 10.1007/BF02589930. [DOI] [PubMed] [Google Scholar]
  16. Lyss A. P. Appendiceal malignancies. Semin Oncol. 1988 Apr;15(2):129–137. [PubMed] [Google Scholar]
  17. Menon N. K. Primary adenocarcinoma of the appendix. Postgrad Med J. 1980 Jun;56(656):448–450. doi: 10.1136/pgmj.56.656.448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moertel C. G., Weiland L. H., Nagorney D. M., Dockerty M. B. Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med. 1987 Dec 31;317(27):1699–1701. doi: 10.1056/NEJM198712313172704. [DOI] [PubMed] [Google Scholar]
  19. Otto R. E., Ghislandi E. V., Lorenzo G. A., Conn J., Jr Primary appendiceal adenocarcinoma. Am J Surg. 1970 Dec;120(6):704–706. doi: 10.1016/s0002-9610(70)90061-9. [DOI] [PubMed] [Google Scholar]
  20. Pugeda F. V., Hinshaw J. R. Primary adenocarcinoma of the appendix. Dis Colon Rectum. 1969 Nov-Dec;12(6):457–461. doi: 10.1007/BF02617734. [DOI] [PubMed] [Google Scholar]
  21. Qizilbash A. H. Primary adenocarcinoma of the appendix. A clinicopathological study of 11 cases. Arch Pathol. 1975 Oct;99(10):556–562. [PubMed] [Google Scholar]
  22. Rutledge R. H., Alexander J. W. Primary appendiceal malignancies: rare but important. Surgery. 1992 Mar;111(3):244–250. [PubMed] [Google Scholar]
  23. SEDDON J. A. ADENOCARCINOMA OF THE APPENDIX ASSOCIATED WITH MULTIPLE ADENOCARCINOMAS OF THE COLON. Am Surg. 1965 Mar;31:180–183. [PubMed] [Google Scholar]
  24. SIERACKI J. C., TESLUK H. Primary adenocarcinoma of the vermiform appendix. Cancer. 1956 Sep-Oct;9(5):997–1011. doi: 10.1002/1097-0142(195609/10)9:5<997::aid-cncr2820090520>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  25. Steinberg M., Cohn I., Jr Primary adenocarcinoma of the appendix. Surgery. 1967 Apr;61(4):644–660. [PubMed] [Google Scholar]
  26. Sugarbaker P. H., Kern K., Lack E. Malignant pseudomyxoma peritonei of colonic origin. Natural history and presentation of a curative approach to treatment. Dis Colon Rectum. 1987 Oct;30(10):772–779. doi: 10.1007/BF02554625. [DOI] [PubMed] [Google Scholar]
  27. WILSON R. Primary carcinoma of the appendix. Am J Surg. 1962 Aug;104:238–249. doi: 10.1016/0002-9610(62)90324-0. [DOI] [PubMed] [Google Scholar]
  28. Warkel R. L., Cooper P. H., Helwig E. B. Adenocarcinoid, a mucin-producing carcinoid tumor of the appendix: a study of 39 cases. Cancer. 1978 Dec;42(6):2781–2793. doi: 10.1002/1097-0142(197812)42:6<2781::aid-cncr2820420638>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  29. Wolff M., Ahmed N. Epithelial neoplasms of the vermiform appendix (exclusive of carcinoid). I. Adenocarcinoma of the appendix. Cancer. 1976 May;37(5):2493–2510. doi: 10.1002/1097-0142(197605)37:5<2493::aid-cncr2820370543>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES