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Colorectal

E111: Patterns of presentation and delivery of care of appendiceal neoplasms in the municipal safety-net setting.

    ePoster Abstract Author(s)

  • Armaan Ahmed

    Undergraduate Student
    Johns Hopkins University
    Larchmont, New York, United States

    • Submitter(s)

  • Armaan Ahmed

    Undergraduate Student
    Johns Hopkins University
    Larchmont, New York, United States

    • Author(s)

  • Armaan Ahmed

    Undergraduate Student
    Johns Hopkins University
    Larchmont, New York, United States

  • JW

    Jennifer Whittington, MD, PhD, FACS, FSSO

    Attending Surgeon and Assistant Professor of Surgery
    Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA, Department of Surgery, Icahn School of Medicine, New York, NY, USA, United States

  • Zahra Shafaee, MD, MBA, FSSO, FACS (she/her/hers)

    Attending Surgeon and Assistant Professor of Surgery
    Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA, Department of Surgery, Icahn School of Medicine, New York, NY, USA
    Larchmont, New York, United States

Introduction:

Appendiceal neoplasms (AN) are rare tumors with a broad spectrum of referral and treatment patterns. Here, we study patterns of presentation and management of AN in a large municipal health care delivery system.

Methods:

We identified 92 patients with AN between 01/01/2017 to 07/01/2023 in a retrospective case review. Demographic, diagnostic, and primary surgery variables were captured for all cases, and, for the non-neuroendocrine cases, genetic, stage, and further treatment variables were noted. Statistical analyses were performed in Python.

Results:

There were 38 (41.3%) mucinous neoplasms, 24 (26.1%) adenocarcinomas, 23 (25.0%) neuroendocrine, and 7 (7.6%) ex-goblet cell adenocarcinomas. 16 cases of pseudomyxoma peritonei were identified. The median age at diagnosis was 55 (IQR: 45-65). 49% were Hispanic, and African Americans were the largest racial block (28%). 50% of cases presented as appendicitis. In this group, appendectomy and a second surgical intervention was significantly more commonly performed (p< 0.001 and p=0.044, respectively). Other surgical interventions included colon resections and cytoreduction ± Hyperthermic intraperitoneal chemotherapy. Among the patients with mucinous neoplasm or adenocarcinoma, 35 (50.7%) had multidisciplinary tumor board discussion (15 mucinous neoplasm and 20 adenocarcinomas). The median follow-up period was 22.0 months (95% CI: 11.5-30.7 months). Surveillance modalities included CT (75%), CEA (74%), and colonoscopy (35%). 85% remained within HHC during treatment. 16 patients were planned to have chemotherapy, including 9 pseudomyxoma peritonei cases. 5 patients did not follow through, and the other cases had a median of 10 cycles. The following adjuvant chemotherapy regimens were employed: 50% FOLFOX, 20% FOLFIRI, 20% XELODA, and 10% CapeOX and FOLFIRI. There were 2 cancer-related deaths (pseudomyxomas). Excluding pseudomyxomas, none had evidence of disease at the last follow-up.

Conclusions:

Minorities and immigrants constitute the majority of the population in this institutional retrospective case review. 50% of AN presented as appendicitis emphasizing the need for a robust system to identify these cases. Despite challenges encountered in providing long-term oncological care, vigorous follow-up has been provided for this underserved population.

Learning Objectives:

  • Describe patterns of presentation of appendiceal neoplasms.
  • Understand the patient retention rate in the safety-net setting for appendiceal neoplasms.
  • Identify the state of diagnosis, treatment, and surveillance of appendiceal neoplasms in the safety-net setting.