Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix in a National Cohort: A Call to Further Decrease Colectomy

Infographic · Aug 2025 · 1 min read

In brief

National cohort study of 1,339 pediatric patients demonstrates that appendectomy alone achieves excellent 5-year survival (99.9%) for appendiceal neuroendocrine tumors, even with positive margins. Right hemicolectomy offers no survival benefit and should be avoided in children, contrary to adult treatment guidelines.

Appendectomy alone is safe and effective for pediatric appendiceal NETs, even with positive margins—no survival benefit from right hemicolectomy
5-year survival for pediatric appendiceal NET after appendectomy is 99.9%, regardless of tumor size, margins, or lymph node status
14% of children still undergo unnecessary right hemicolectomy based on adult guidelines—pediatric-specific approach should be standard
Positive margins on appendectomy do not warrant additional resection in children with appendiceal neuroendocrine tumors
Lymph node assessment and extended resection add morbidity without improving outcomes in pediatric appendiceal NET

Written by the GCMD Library team from the infographic.

Background: Children continue to undergo right hemicolectomy (RHC) for neuroendocrine tumors (NET) of the appendix based on adult guidelines. Appendectomy alone is recommended for the pediatric population; however, there are no data on safety of this approach in the setting of positive margins. This study aimed to determine the association between tumor characteristics and survival in a national cohort, hypothesizing that survival would be excellent despite high-risk features including positive margins on appendectomy.

Study design: Patients aged ≤ 18 years with NET of the appendix were identified in the National Cancer Database from 2004 to 2022 using ICD-O-3 codes. Characteristics of patients who underwent definitive appendectomy vs RHC were compared using Chi-square tests. Five-year survival was determined for appendectomy patients with and without high-risk size, margin, and lymph node (LN) features.

Results: Of 1,339 patients, 1,156 (86%) underwent appendectomy and 183 (14%) RHC. Median age in both groups was 15 (13, 17) years. Patients who underwent RHC had larger tumors (24% vs 4% >2 cm, p<.001), more lymphovascular invasion (31% vs 10%, p<.001), and were more likely to undergo LN assessment (82% vs 10%, p<.001) with a higher LN positivity rate (31% vs 16%, p=.006). There was no difference in margins status (p=0.76). The 5- and 10-year survival was excellent regardless of tumor characteristics for patients overall (99.9% and 99.4%, respectively) and for those who underwent definitive appendectomy (99.9% and 99.2%).

Conclusion: These data further support appendectomy as definitive management for children with appendiceal NET. Additional resection does not confer a survival benefit even in the setting of positive margins.