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

C. dric Nesti; Konstantin Bräutigam; Marta Benavent; Laura Bernal; Hessa Boharoon; Johan Botling; Antonin Bouroumeau; Iva Brcic; Maximilian Brunner; Guillaume Cadiot; Maria Camara; Emanuel Christ; Thomas Clerici; Ashley K. Clift; Hamish Clouston; Lorenzo Cobianchi; Jarosław B. Ćwikła; Kosmas Daskalakis; Andrea Frilling; Rocio Garcia-Carbonero; Simona Grozinsky-Glasberg; Jorge Hernando; Valérie Hervieu; Johannes Hofland; Pernille Holmager; Frediano Inzani; Henning Jann; Paula Jimenez-Fonseca; Enes Kaçmaz; Daniel Kaemmerer; Gregory Kaltsas; Branislav Klimacek; Ulrich Knigge; Agnieszka Kolasińska-Ćwikła; Walter Kolb; Beata Kos-Kudła; Catarina Alisa Kunze; Stefania Landolfi; Stefano La Rosa; Carlos L. pez López; Kerstin Lorenz; Maurice Matter; Peter Mazal; Claudia Mestre-Alagarda; Patricia Morales del Burgo; Els J. M. Nieveen van Dijkum; Kira Oleinikov; Lorenzo A. Orci; Francesco Panzuto; Marianne Pavel; Marine Perrier; Henrik Mikael Reims; Guido Rindi; Anja Rinke; Maria Rinzivillo; Xavier Sagaert; Ilker Satiroglu; Andreas Selberherr; Alexander R. Siebenhüner; Margot E. T. Tesselaar; Michael J. Thalhammer; Espen Thiis-Evensen; Christos Toumpanakis; Timon Vandamme; José G. van den Berg; Alessandro Vanoli; Marie-Louise F. van Velthuysen; Chris Verslype; Stephan A. Vorburger; Alessandro Lugli; John Ramage; Marcel Zwahlen; Aurel Perren; Reto M. Kaderli

doi:https://doi.org/10.1016/S1470-2045(22)00750-1

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

C. dric Nesti, Konstantin Bräutigam, Marta Benavent, Laura Bernal, Hessa Boharoon, Johan Botling, Antonin Bouroumeau, Iva Brcic, Maximilian Brunner, Guillaume Cadiot, Maria Camara, Emanuel Christ, Thomas Clerici, Ashley K. Clift, Hamish Clouston, Lorenzo Cobianchi, Jarosław B. Ćwikła, Kosmas Daskalakis, Andrea Frilling, Rocio Garcia-CarboneroSimona Grozinsky-Glasberg, Jorge Hernando, Valérie Hervieu, Johannes Hofland, Pernille Holmager, Frediano Inzani, Henning Jann, Paula Jimenez-Fonseca, Enes Kaçmaz, Daniel Kaemmerer, Gregory Kaltsas, Branislav Klimacek, Ulrich Knigge, Agnieszka Kolasińska-Ćwikła, Walter Kolb, Beata Kos-Kudła, Catarina Alisa Kunze, Stefania Landolfi, Stefano La Rosa, Carlos L. pez López, Kerstin Lorenz, Maurice Matter, Peter Mazal, Claudia Mestre-Alagarda, Patricia Morales del Burgo, Els J. M. Nieveen van Dijkum, Kira Oleinikov, Lorenzo A. Orci, Francesco Panzuto, Marianne Pavel, Marine Perrier, Henrik Mikael Reims, Guido Rindi, Anja Rinke, Maria Rinzivillo, Xavier Sagaert, Ilker Satiroglu, Andreas Selberherr, Alexander R. Siebenhüner, Margot E. T. Tesselaar, Michael J. Thalhammer, Espen Thiis-Evensen, Christos Toumpanakis, Timon Vandamme, José G. van den Berg, Alessandro Vanoli, Marie-Louise F. van Velthuysen, Chris Verslype, Stephan A. Vorburger, Alessandro Lugli, John Ramage, Marcel Zwahlen, Aurel Perren, Reto M. Kaderli

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Awareness 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. Methods: In 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. Findings: 282 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). Interpretation: This 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. Funding: Swiss Cancer Research foundation.

Original language	English
Pages (from-to)	187-194
Number of pages	8
Journal	The Lancet Oncology
Volume	24
Issue number	2
DOIs	https://doi.org/10.1016/S1470-2045(22)00750-1
Publication status	Published - 1 Feb 2023

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https://doi.org/10.1016/S1470-2045(22)00750-1

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Nesti, C. D., Bräutigam, K., Benavent, M., Bernal, L., Boharoon, H., Botling, J., Bouroumeau, A., Brcic, I., Brunner, M., Cadiot, G., Camara, M., Christ, E., Clerici, T., Clift, A. K., Clouston, H., Cobianchi, L., Ćwikła, J. B., Daskalakis, K., Frilling, A., ... Kaderli, R. M. (2023). Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1–2 cm in size: a retrospective, Europe-wide, pooled cohort study. The Lancet Oncology, 24(2), 187-194. https://doi.org/10.1016/S1470-2045(22)00750-1

@article{a11cd11bbd1148cab5e1a115e8cdbbf5,

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

abstract = "Background: Awareness 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. Methods: In 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. Findings: 282 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). Interpretation: This 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. Funding: Swiss Cancer Research foundation.",

author = "Nesti, {C. dric} and Konstantin Br{\"a}utigam and Marta Benavent and Laura Bernal and Hessa Boharoon and Johan Botling and Antonin Bouroumeau and Iva Brcic and Maximilian Brunner and Guillaume Cadiot and Maria Camara and Emanuel Christ and Thomas Clerici and Clift, {Ashley K.} and Hamish Clouston and Lorenzo Cobianchi and {\'C}wik{\l}a, {Jaros{\l}aw B.} and Kosmas Daskalakis and Andrea Frilling and Rocio Garcia-Carbonero and Simona Grozinsky-Glasberg and Jorge Hernando and Val{\'e}rie Hervieu and Johannes Hofland and Pernille Holmager and Frediano Inzani and Henning Jann and Paula Jimenez-Fonseca and Enes Ka{\c c}maz and Daniel Kaemmerer and Gregory Kaltsas and Branislav Klimacek and Ulrich Knigge and Agnieszka Kolasi{\'n}ska-{\'C}wik{\l}a and Walter Kolb and Beata Kos-Kud{\l}a and Kunze, {Catarina Alisa} and Stefania Landolfi and Rosa, {Stefano La} and L{\'o}pez, {Carlos L. pez} and Kerstin Lorenz and Maurice Matter and Peter Mazal and Claudia Mestre-Alagarda and {del Burgo}, {Patricia Morales} and {van Dijkum}, {Els J. M. Nieveen} and Kira Oleinikov and Orci, {Lorenzo A.} and Francesco Panzuto and Marianne Pavel and Marine Perrier and Reims, {Henrik Mikael} and Guido Rindi and Anja Rinke and Maria Rinzivillo and Xavier Sagaert and Ilker Satiroglu and Andreas Selberherr and Siebenh{\"u}ner, {Alexander R.} and Tesselaar, {Margot E. T.} and Thalhammer, {Michael J.} and Espen Thiis-Evensen and Christos Toumpanakis and Timon Vandamme and {van den Berg}, {Jos{\'e} G.} and Alessandro Vanoli and {van Velthuysen}, {Marie-Louise F.} and Chris Verslype and Vorburger, {Stephan A.} and Alessandro Lugli and John Ramage and Marcel Zwahlen and Aurel Perren and Kaderli, {Reto M.}",

note = "Funding Information: This study was funded by the Swiss Cancer Research foundation (KFS-4741-02-2019) (KFS-4741-02-2019). We are grateful to Kristien Dumon, Angelika Kogut, and Giuseppe Quero, for their help in data compilation. Furthermore, we thank Karine Atlan and Fiona Rodepeter for revising pathological samples of patients. Additionally, we thank Shira Baram and Steven Brown for their support in the process to prepare our study in the UK. Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd",

year = "2023",

month = feb,

day = "1",

doi = "https://doi.org/10.1016/S1470-2045(22)00750-1",

language = "English",

volume = "24",

pages = "187--194",

journal = "The Lancet Oncology",

issn = "1470-2045",

publisher = "Lancet Publishing Group",

number = "2",

}

Nesti, CD, Bräutigam, K, Benavent, M, Bernal, L, Boharoon, H, Botling, J, Bouroumeau, A, Brcic, I, Brunner, M, Cadiot, G, Camara, M, Christ, E, Clerici, T, Clift, AK, Clouston, H, Cobianchi, L, Ćwikła, JB, Daskalakis, K, Frilling, A, Garcia-Carbonero, R, Grozinsky-Glasberg, S, Hernando, J, Hervieu, V, Hofland, J, Holmager, P, Inzani, F, Jann, H, Jimenez-Fonseca, P, Kaçmaz, E, Kaemmerer, D, Kaltsas, G, Klimacek, B, Knigge, U, Kolasińska-Ćwikła, A, Kolb, W, Kos-Kudła, B, Kunze, CA, Landolfi, S, Rosa, SL, López, CLP, Lorenz, K, Matter, M, Mazal, P, Mestre-Alagarda, C, del Burgo, PM, van Dijkum, EJMN, Oleinikov, K, Orci, LA, Panzuto, F, Pavel, M, Perrier, M, Reims, HM, Rindi, G, Rinke, A, Rinzivillo, M, Sagaert, X, Satiroglu, I, Selberherr, A, Siebenhüner, AR, Tesselaar, MET, Thalhammer, MJ, Thiis-Evensen, E, Toumpanakis, C, Vandamme, T, van den Berg, JG, Vanoli, A, van Velthuysen, M-LF, Verslype, C, Vorburger, SA, Lugli, A, Ramage, J, Zwahlen, M, Perren, A & Kaderli, RM 2023, 'Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1–2 cm in size: a retrospective, Europe-wide, pooled cohort study', The Lancet Oncology, vol. 24, no. 2, pp. 187-194. https://doi.org/10.1016/S1470-2045(22)00750-1

TY - JOUR

T1 - Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1–2 cm in size

T2 - a retrospective, Europe-wide, pooled cohort study

AU - Nesti, C. dric

AU - Bräutigam, Konstantin

AU - Benavent, Marta

AU - Bernal, Laura

AU - Boharoon, Hessa

AU - Botling, Johan

AU - Bouroumeau, Antonin

AU - Brcic, Iva

AU - Brunner, Maximilian

AU - Cadiot, Guillaume

AU - Camara, Maria

AU - Christ, Emanuel

AU - Clerici, Thomas

AU - Clift, Ashley K.

AU - Clouston, Hamish

AU - Cobianchi, Lorenzo

AU - Ćwikła, Jarosław B.

AU - Daskalakis, Kosmas

AU - Frilling, Andrea

AU - Garcia-Carbonero, Rocio

AU - Grozinsky-Glasberg, Simona

AU - Hernando, Jorge

AU - Hervieu, Valérie

AU - Hofland, Johannes

AU - Holmager, Pernille

AU - Inzani, Frediano

AU - Jann, Henning

AU - Jimenez-Fonseca, Paula

AU - Kaçmaz, Enes

AU - Kaemmerer, Daniel

AU - Kaltsas, Gregory

AU - Klimacek, Branislav

AU - Knigge, Ulrich

AU - Kolasińska-Ćwikła, Agnieszka

AU - Kolb, Walter

AU - Kos-Kudła, Beata

AU - Kunze, Catarina Alisa

AU - Landolfi, Stefania

AU - Rosa, Stefano La

AU - López, Carlos L. pez

AU - Lorenz, Kerstin

AU - Matter, Maurice

AU - Mazal, Peter

AU - Mestre-Alagarda, Claudia

AU - del Burgo, Patricia Morales

AU - van Dijkum, Els J. M. Nieveen

AU - Oleinikov, Kira

AU - Orci, Lorenzo A.

AU - Panzuto, Francesco

AU - Pavel, Marianne

AU - Perrier, Marine

AU - Reims, Henrik Mikael

AU - Rindi, Guido

AU - Rinke, Anja

AU - Rinzivillo, Maria

AU - Sagaert, Xavier

AU - Satiroglu, Ilker

AU - Selberherr, Andreas

AU - Siebenhüner, Alexander R.

AU - Tesselaar, Margot E. T.

AU - Thalhammer, Michael J.

AU - Thiis-Evensen, Espen

AU - Toumpanakis, Christos

AU - Vandamme, Timon

AU - van den Berg, José G.

AU - Vanoli, Alessandro

AU - van Velthuysen, Marie-Louise F.

AU - Verslype, Chris

AU - Vorburger, Stephan A.

AU - Lugli, Alessandro

AU - Ramage, John

AU - Zwahlen, Marcel

AU - Perren, Aurel

AU - Kaderli, Reto M.

N1 - Funding Information: This study was funded by the Swiss Cancer Research foundation (KFS-4741-02-2019) (KFS-4741-02-2019). We are grateful to Kristien Dumon, Angelika Kogut, and Giuseppe Quero, for their help in data compilation. Furthermore, we thank Karine Atlan and Fiona Rodepeter for revising pathological samples of patients. Additionally, we thank Shira Baram and Steven Brown for their support in the process to prepare our study in the UK. Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Background: Awareness 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. Methods: In 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. Findings: 282 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). Interpretation: This 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. Funding: Swiss Cancer Research foundation.

AB - Background: Awareness 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. Methods: In 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. Findings: 282 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). Interpretation: This 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. Funding: Swiss Cancer Research foundation.

UR - http://www.scopus.com/inward/record.url?scp=85147216678&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/S1470-2045(22)00750-1

DO - https://doi.org/10.1016/S1470-2045(22)00750-1

M3 - Article

C2 - 36640790

SN - 1470-2045

VL - 24

SP - 187

EP - 194

JO - The Lancet Oncology

JF - The Lancet Oncology

IS - 2

ER -

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

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