Distant Metastases and Long‐Term Survival After Complete Resection of Neuroendocrine
Tumors of the Appendix (SurvivApp)

Bern University Hospital, University of Bern

Bern, Switzerland


Reto KADERLI, [email protected]

Aurel PERREN, [email protected]

Cédric NESTI, [email protected]


The evidence for right‐sided oncological hemicolectomy for appendiceal neuroendocrine tumors (aNET) measuring 1 – 2 cm is scarce. Current ENETS guidelines are based on expert opinion and limited literature. As right‐sided oncological hemicolectomy is associated with a significant morbidity and mortality, its indication should be questioned critically.


Based on current data and an own retrospective analysis of 197 consecutively treated aNET patients with central review of the histological specimens, we hypothesize that the mortality rate of aNET measuring 1 – 2 cm is less than 1% and regional lymph node metastases of aNET measuring 1 – 2 cm are clinically not relevant. If confirmed, these estimates would imply that oncological right‐sided hemicolectomy has no impact on long‐term survival after complete resection of aNET measuring 1 ‐ 2 cm and that the malignant potential quo ad vitam of these tumors is lower than the risk of oncological hemicolectomy.


The university of Bern has set up a retrospective data collection among the ENETS Centers of Excellence. We kindly ask you to participate in the retrospective analysis of clinicopathological data of patients with aNET measuring 1 – 2 cm, operated between 2000 and 2010. The patient inclusion ends 28.02.2021. Between March and September 2020, a surgical resident from Bern University Hospital will visit all participating ENETS Centers of Excellence for data collection. Tissue blocks of deceased or distant metastatic patients will be organised when inclusion is finished by a resident from the Institute of Pathology, University of Bern, for central histopathological review.


The present study is supported by ENETS. Europe‐wide careful evaluation of clinicopathological data will provide the most comprehensive and up‐to‐date evidence base for physicians, guideline developers, and other decision makers in the health care system for the treatment of aNET and the evaluation of the necessity of oncological right‐sided hemicolectomy.


To date, the following centers have confirmed their participation:

  • ENETS Center of Excellence for Neuroendocrine Tumors, Amsterdam Universitair Medische Centra (UMC)
  • Academisch Medisch Centrum (AMC) Amsterdam
  • Universitair Ziekenhuis Antwerpen (UZA)
  • EKPA-Laiko ENETS CoE, Athens
  • Zentralklinik Bad Berka GmbH, Germany
  • Vall d'Hebron University Hospital, Barcelona
  • University Hospital Basel, Switzerland
  • Charité Berlin
  • Universitätsspital Bern (Inselspital)
  • Semmelweis University Budapest
  • Neuroendocrine Tumor Center of Excellence Rigshospitalet, University of Copenhagen, Denmark
  • Trinity College Dublin, the University of Dublin
  • Universitätsklinikum Erlangen
  • University of Glasgow
  • LKH-Univ. Klinikum Graz
  • NET Centrum Hamburg, Germany
  • Medizinische Universität Innsbruck
  • Hadassah-Hebrew University Medical Center Jerusalem
  • Kent and Hampshire Hospitals
  • Centre Hospitalier Universitaire Vaudois, Lausanne
  • University Hospital Gasthuisberg, UZ Leuven
  • Imperial College London
  • Royal Free Hospital, London
  • Hospital Universitario Doce de Octubre, Madrid
  • Hospital Universitario La Paz, Madrid
  • The Christie NHS Foundation, Manchester
  • NET Zentrum Marburg, Germany
  • Universitetssykehus Oslo
  • Hospital Universitario Central de Asturias, Oviedo
  • Oxford University Hospital
  • Fondazione IRCCS Policlinico San Matteo, University of Pavia
  • Centre hospitalier universitaire, Reims
  • Policlinico Gemelli, Roma
  • Clinico azienda ospedaliero-universitaria Sant’Andrea, Roma
  • ENETS centre of excellence Erasmus MC Rotterdam, Netherlands
  • U. Marqués de Valdecilla, Santander
  • Medical University of Silesia
  • University Hospital Southampton
  • Medical University of Vienna, Austria
  • Department of Endocrine Oncology, Uppsala University Hospital, Sweden.

The approval of the present study by the Ethics Committee Bern, Switzerland, and the detailed study protocol are attached.


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