eP162 - The Rate of Synchronous Appendiceal Neoplasia and the Role of Prophylactic Appendectomy During Colorectal Cancer Resection

Purpose/Background: Patients with colorectal cancer (CRC) may be at increased risk of appendiceal neoplasia (AN), either synchronous or metachronous. There is a documented increase in AN, which typically presents in an advanced stage requiring substantial resources and associated with significant morbidity/mortality. European study of prophylactic appendectomy during CRC resection reveals a significant rate of synchronous AN. The present study examined the rate of synchronous AN with rectal cancer found after routine prophylactic appendectomy performed during oncologic resection of the rectum.Methods/Interventions: A retrospective review of 81 consecutive rectal cancer patients (all with an intact appendix) who underwent neoadjuvant therapy followed by open oncologic resection of the rectum with prophylactic appendectomy performed between 1999 and 2010. The rate of AN in the pathologic specimen was compared with a literature review of similar studies.Results/Outcomes: Of the 81 normal appearing appendices removed, pathologic examination revealed that one specimen contained a 0.9 cm carcinoid (neuroendocrine tumor) for a 1.2% rate of AN. Literature review revealed limited published studies on the subject with European studies reporting a 3-4% rate of synchronous AN, supporting prophylactic appendectomy during CRC resection (Table 1).Conclusion/

Discussion: The rate of synchronous AN during rectal cancer resection in this study combined with European studies of CRC resection (3-4% rate of synchronous AN) support prophylactic appendectomy during CRC resection as a valid strategy to eliminate both synchronous AN and the potential for metachronous AN and its attendant poor outcomes. Further study of prophylactic appendectomy during CRC resection is warranted.Table 1Literature Review of Published Studies of Appendix Pathology Following Prophylactic Appendectomy During Resection for CRC