Evidence map›Paper›PMID 40640613›Full record

ArticleEndocrine2025

Safety and cost-effectiveness of immediate right hemicolectomy versus active surveillance for well-differentiated appendiceal neuroendocrine tumors 1-2 cm in size: a Markov decision analysis.

Claudio Ricci, Stefano Partelli, Davide Campana, Maria Rinzivillo, Laura Alberici, Elisa Andrini, Sofia Menin, Vincenzo D'Ambra, Anna Battistella, Valentina Andreasi and 3 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Claudio RicciDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy. claudio.ricci6@unibo.it.
Stefano PartelliPancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, ENETS Center of Excellence, Milan, Italy.
Davide CampanaDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Maria RinzivilloDigestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence or Rome, Rome, Italy.
Laura AlbericiDivision of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
Elisa AndriniDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Sofia MeninDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Vincenzo D'AmbraDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Anna BattistellaPancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, ENETS Center of Excellence, Milan, Italy.
Valentina AndreasiPancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, ENETS Center of Excellence, Milan, Italy.
Riccardo CasadeiDepartment of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Massimo FalconiPancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, ENETS Center of Excellence, Milan, Italy.
Francesco PanzutoDigestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence or Rome, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTherapeutic management of appendiceal neuroendocrine neoplasms (a-NENs) 10-20 mm in size represents a challenge for both surgeons and oncologists. We compared active surveillance after appendectomy versus immediate right hemicolectomy (RHC).

methodsA Markov decision model was developed based on literature parameters. The endpoints were the life expectancy, the quality-adjusted life expectancy (QALY), and the cost-effective ratio expressed by the incremental cost-effective ratio (ICER). A deterministic sample analysis (DSA) with one-way sensitivity analysis was performed for the base case scenario. A probabilistic sensitivity analysis (PSA) was performed to solve the uncertainty of the model. Montecarlo simulation with 100,000 replications for each arm was used. Data are reported in US$. The acceptability of the strategy was set 3 times ($130,049) the Euro area's gross domestic product per capita ($43,394).

resultsThe 10-year survival rates for active surveillance and immediate RHC were 98.2 and 98.9%, respectively. The DSA showed the superiority of active surveillance versus immediate RHC (10 versus 9.0 QALY). Active surveillance costs more than immediate RHC ($35,761 vs. $39,486). The resulting ICER was $4302 per QALY. The model was more sensitive to the length of follow-up (99.9% variability): the longer the surveillance, the higher the ICER (spread $302,703). PSA analysis confirmed active surveillance as the most cost-effective choice, costing an ICER + $4059 per QALY.

conclusionActive surveillance is safe and cost-effective in patients with appendiceal NENs of 10-20 mm in size, both clinically and economically.

Indexed as

Appendiceal NeoplasmsColectomyNeuroendocrine TumorsWatchful WaitingAdultAppendectomyCost-Benefit AnalysisDecision Support TechniquesFemaleHumansMaleMarkov ChainsMiddle AgedQuality-Adjusted Life YearsAppendiceal neuroendocrine neoplasmsCost-effectivenessGuidelinesHemicolectomy

Identifiers

PMID40640613

What OpenQuestion holds

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Registered trials

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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.