Evidence map›Paper›PMID 36640790›Full record

ArticleThe Lancet. Oncology2023

Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study.

Cédric Nesti, Konstantin Bräutigam, Marta Benavent, Laura Bernal, Hessa Boharoon, Johan Botling, Antonin Bouroumeau, Iva Brcic, Maximilian Brunner, Guillaume Cadiot and 64 more

2 registry-linked trialsOpen access · greenAbstract read
PubMed Publisher
In one paragraph

Article in The Lancet. Oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 45 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 2 pooled it
20.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03852693 completednot on this map

Distant Metastases and Long-Term Survival After Complete Resection of Neuroendocrine Tumors of the Appendix: An International Multicenter Study

Typeobservational_patient_registrySponsorInsel Gruppe AG, University Hospital BernRan2020 to 2022Enrolled278ConditionsNeuroendocrine Tumors of the AppendixArmsHistopathological review
NCT05907824 unknown statusnot on this map

Long-term Prognosis Comparison Between Parenchyma-sparing and Oncologic Resections for Non-functional Neuroendocrine Tumors of the Pancreatic Body and Tail ≤ 3cm: a Real-world Data Study

TypeobservationalSponsorFudan UniversityRan2023 to 2023Enrolled800ConditionsNon Functioning Pancreatic Endocrine TumorArmsHistopathological review, long-term prognosis and quality of life follow-up
3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 2 syntheses or guidelines pooled it, 64 citations in OpenAlex.

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  15. [Neuroendocrine tumors].Pathologie (Heidelberg, Germany) · 2025
    Review
  16. Rectal neuroendocrine tumors: Can we predict their behavior?World journal of gastroenterology · 2025
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

74 authors at 20 institutions in 16 countries.

Cédric NestiDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Konstantin BräutigamInstitute of Pathology, University of Bern, Bern, Switzerland.
Marta BenaventDepartment of Medical Oncology, University Hospital Virgen del Rocío, Instituto de Biomedicina De Sevilla, Seville, Spain.
Laura BernalDepartment of Medical Oncology, University Hospital Virgen del Rocío, Instituto de Biomedicina De Sevilla, Seville, Spain.
Hessa BoharoonNeuroendocrine Tumour Unit-ENETS Centre of Excellence, Royal Free Hospital London, London, UK.
Johan BotlingDepartment of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Antonin BouroumeauDivision of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
Iva BrcicDiagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
Maximilian BrunnerDepartment of Surgery, University Hospital of Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
Guillaume CadiotService d'Hépato-gastroentérologie et d'Oncologie Digestive, Université Reims Champagne Ardenne, CHU de Reims, Reims, France.
Maria CamaraPathology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
Emanuel ChristDepartment of Endocrinology, Diabetology and Metabolism, ENETS Center of Excellence, University Hospital of Basel, Basel, Switzerland.
Thomas ClericiKlinik für Allgemein-, Viszeral-, Endokrin- und Transplantationschirurgie, Kantonsspital St Gallen, St Gallen, Switzerland.
Ashley K CliftDepartment of Surgery and Cancer, Imperial College London, London, UK.
Hamish CloustonColorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
Lorenzo CobianchiDepartment of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of General Surgery, IRCCS Policlinico San Matteo Fondazione, Pavia, Italy.
Jarosław B ĆwikłaIndywidualna Specjalistyczna Praktyka Lekarska, Warsaw, Poland.
Kosmas Daskalakis1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian University of Athens, ENETS Center of Excellence, Athens, Greece.
Andrea FrillingDepartment of Surgery and Cancer, Imperial College London, London, UK.
Rocio Garcia-CarboneroOncology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, Madrid, Spain.
Simona Grozinsky-GlasbergNeuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Jorge HernandoMedical Oncology Department, Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology, Barcelona, Spain.
Valérie HervieuHospices Civils de Lyon, HEH, Lyon, France.
Johannes HoflandDepartment of Internal Medicine, Section of Endocrinology ENETS Center of Excellence and Erasmus Cancer Institute, Erasmus MC, Rotterdam, Netherlands.
Pernille HolmagerENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Frediano InzaniGeneral Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy.
Henning JannHepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany.
Paula Jimenez-FonsecaDepartment of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
Enes KaçmazDepartment of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Daniel KaemmererDepartment of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
Gregory Kaltsas1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian University of Athens, ENETS Center of Excellence, Athens, Greece.
Branislav KlimacekDepartment of Surgery, Endocrine Surgical Unit, Uppsala University, Uppsala, Sweden.
Ulrich KniggeENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Agnieszka Kolasińska-ĆwikłaThe Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Walter KolbKlinik für Allgemein-, Viszeral-, Endokrin- und Transplantationschirurgie, Kantonsspital St Gallen, St Gallen, Switzerland.
Beata Kos-KudłaDepartment of Endocrinology and Neuroendocrine Neoplasms and Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland.
Catarina Alisa KunzeInstitute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Stefania LandolfiPathology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Stefano La RosaInstitute of Pathology, Department of Laboratory Medicine and Pathology, University of Lausanne, Lausanne, Switzerland; Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Carlos López LópezMedical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
Kerstin LorenzDepartment of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Halle, Germany.
Maurice MatterDepartment of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Peter MazalDepartment of Clinical Pathology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
Claudia Mestre-AlagardaHistopathology, Institute of Liver Studies, King's College Hospital, London, UK.
Patricia Morales Del BurgoDepartment of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Els J M Nieveen van DijkumDepartment of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Kira OleinikovNeuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Lorenzo A OrciDivision of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Francesco PanzutoDepartment of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
Marianne PavelDepartment of Medicine 1, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Marine PerrierService d'Hépato-gastroentérologie et d'Oncologie Digestive, Université Reims Champagne Ardenne, CHU de Reims, Reims, France.
Henrik Mikael ReimsDepartment of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Guido RindiUnit of Head and Neck, Lung, and Endocrine Pathology, Department of Woman and Child Health Science and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Roma European NeuroEndocrine Tumor Society Center of Excellence, Rome, Italy; Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
Anja RinkeDepartment of Gastroenterology and Endocrinology, UKGM, Marburg, Germany; Philipps University Marburg, Marburg, Germany.
Maria RinzivilloDigestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
Xavier SagaertTranslational Cell & Tissue Research, KU Leuven, Leuven, Belgium.
Ilker SatirogluDepartment of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Halle, Germany.
Andreas SelberherrDivision of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
Alexander R SiebenhünerKlinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich und Universität Zürich, Zurich, Switzerland; Departement Medizinische Onkologie, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
Margot E T TesselaarDepartment of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
Michael J ThalhammerDepartment of Surgery, Division of Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.
Espen Thiis-EvensenDepartment of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Christos ToumpanakisNeuroendocrine Tumour Unit-ENETS Centre of Excellence, Royal Free Hospital London, London, UK.
Timon VandammeUniversity Hospital Antwerp, Edegem, Belgium.
José G van den BergDepartment of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
Alessandro VanoliUnit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Unit of Anatomic Pathology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Marie-Louise F van VelthuysenDepartment of Pathology, Erasmus MC, Rotterdam, Netherlands.
Chris VerslypeClinical Digestive Oncology, University Hospitals Leuven, Belgium.
Stephan A VorburgerSurgical Department, Teaching Hospitals Emmental, Burgdorf, Switzerland.
Alessandro LugliInstitute of Pathology, University of Bern, Bern, Switzerland.
John RamageUniversity of Winchester, Winchester, UK; Hampshire Hospital, Basingstoke, UK.
Marcel ZwahlenInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Aurel PerrenInstitute of Pathology, University of Bern, Bern, Switzerland.
Reto M KaderliDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: reto.kaderli@insel.ch.
University of Bern · CHAmsterdam University Medical Centers · NLAzienda Ospedaliera Sant'Andrea · ITCentre Hospitalier Universitaire de Reims · FRCopenhagen University Hospital · DKFriedrich-Alexander-Universität Erlangen-Nürnberg · DEHebrew University of Jerusalem · ILHospital Universitario 12 De Octubre · ESHospital Universitario Central de Asturias · ESImperial College London · GBInstituto de Biomedicina de Sevilla · ESKantonsspital St. Gallen · CHKU Leuven · BEMartin Luther University Halle-Wittenberg · DEMedical University of Graz · ATNational and Kapodistrian University of Athens · GROslo University Hospital · NOThe Netherlands Cancer Institute · NLThe Royal Free Hospital · GBUniversity Hospital of Geneva · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAwareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1-2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1-2 cm in size in patients with or without right-sided hemicolectomy.

methodsIn this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1-2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693.

findings282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1-2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0-15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 -21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36-2·17]; p=0·71).

interpretationThis study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1-2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort.

fundingSwiss Cancer Research foundation.

Indexed as

Appendiceal NeoplasmsNeuroendocrine TumorsAdultAppendectomyCohort StudiesColectomyEuropeFemaleHumansIntestinal NeoplasmsLymphatic MetastasisMalePancreatic NeoplasmsRetrospective StudiesStomach Neoplasms

Identifiers

PMID36640790
OpenAlexW4315629539

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.