Adenocarcinoma as a Cause of Acute Appendicitis

Adenocarcinoma as a cause of acute appendicitis is unusual, occurring in approximately 1.0% of all cases of appendicitis. Nevertheless, management of appendiceal adenocarcinoma as a routine appendicitis may have an adverse outcome for the patient. Iatrogenically, a contained malignant process may be converted into a disseminated disease that will have a lethal outcome. Staging of appendiceal adenocarcinoma and the shortcomings of the TNM are reviewed. The new standard of management for a contained or disseminated appendiceal neoplasm presenting as acute appendicitis is presented. The integrity of the thin wall of the appendix, both before and after the resection of an appendiceal neoplasm is crucial in optimal treatment planning. The histologic grade of invasive versus non-invasive disease and the extent of disease outside the appendix are important prognostic indicators. Cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC) are now standard of care if peritoneal dissemination is documented. Judgments regarding the need for right colon resection as compared to appendectomy only in patients with different grade histology are described. Adenocarcinoma as a cause of appendicitis is rare but since appendicitis is such a common disease process, the general surgeon and surgical oncologist must be prepared to definitively treat an appendiceal neoplasm. There are new paradigms for patient management that are now a standard of care.