Appendix Cancer Surgery in Uberlândia-MG

In most cases, appendix cancer causes no specific symptoms and is discovered incidentally during an appendectomy performed for suspected acute appendicitis — pain in the right lower quadrant of the abdomen, nausea, and low-grade fever. In larger tumors or with peritoneal spread, progressive abdominal distension, a sensation of fullness, a palpable mass, or changes in bowel habits may occur. In the presence of persistent abdominal pain, the patient should seek medical evaluation for proper investigation.

Diagnosis is often established only after histopathological examination of the appendix removed during an appendectomy. When there is prior suspicion, computed tomography of the abdomen and pelvis and magnetic resonance imaging help assess tumor extent and peritoneal spread, while colonoscopy may be indicated to rule out associated lesions in the colon. Tumor markers such as CEA, CA 19-9, and CA 125 assist in monitoring mucinous cases but do not replace histological confirmation.

Duration varies according to the technique indicated. An oncologic appendectomy usually takes between 40 and 90 minutes, while a right colectomy with lymphadenectomy, performed via open, laparoscopic, or robotic approach, generally lasts between 2 and 4 hours. Cases with peritoneal spread that require cytoreductive surgery combined with HIPEC can extend for several hours. The exact duration depends on intraoperative findings and should be discussed individually before the procedure.

These procedures are performed under general anesthesia, with a prior pre-anesthetic evaluation to check the patient's clinical condition. In some protocols, complementary analgesia, such as abdominal wall blocks, is added to reduce the need for opioids after surgery. The final choice of anesthetic technique is made by the anesthesiology team, together with the surgeon, considering the extent of the surgery and the patient's health history.

After an isolated oncologic appendectomy, discharge usually occurs within 1 to 2 days. Right colectomy generally requires 3 to 5 days of hospitalization, which may vary according to the patient's progress, the surgical approach used, and the presence of comorbidities. More extensive surgeries, such as cytoreductive procedures with HIPEC, require a longer hospital stay. These timeframes are estimates and may change according to individual recovery.

Discomfort is expected, especially in the first 48 to 72 hours, and is usually controlled with scheduled analgesia, combining anti-inflammatory drugs, common analgesics, and, when necessary, opioids at adjusted doses. Laparoscopic or robotic procedures tend to involve less incisional pain than the open approach. The intensity and duration of pain vary according to the extent of the surgery and each patient's individual sensitivity.

In simple appendectomies, a drain is generally not necessary. In right colectomies or more extensive surgeries, the surgeon may opt for the temporary use of an abdominal drain and a urinary catheter, removed within the first postoperative days according to clinical progress. A nasogastric tube is used only in specific situations. The need for these devices is assessed on a case-by-case basis, during surgery and postoperative follow-up.

With the laparoscopic or robotic approach, the scars are small incisions, generally between 0.5 and 1.2 cm, distributed across the abdomen. With the open approach, when indicated, the incision is usually larger, in the right lower quadrant or midline region, depending on the extent of the resection. The final appearance of the scar varies according to each patient's individual healing pattern and postoperative care, and should be discussed with the surgeon beforehand.

For light activities, return to work after oncologic appendectomy usually occurs between 1 and 2 weeks. After right colectomy, time away generally ranges from 3 to 4 weeks, and may be longer for jobs requiring physical effort. These timeframes are approximate: they depend on the surgical approach, the occurrence of complications, and individual recovery, and should be confirmed by the responsible surgeon during follow-up.

As with any abdominal surgery, there are risks of bleeding, surgical site infection, fistula or anastomotic dehiscence in colectomy, injury to adjacent structures, and thromboembolic events. Cases with extensive peritoneal spread may be contraindicated for cytoreductive surgery, depending on the peritoneal carcinomatosis index. Severe comorbidities and unstable clinical conditions may require prior optimization. Each case is evaluated individually with regard to risks and benefits.

Not every case requires additional treatment: small, localized neuroendocrine tumors treated with appendectomy usually do not require chemotherapy. Adenocarcinomas with risk factors or peritoneal spread, however, may require systemic or intraperitoneal chemotherapy, determined jointly with clinical oncology. Follow-up usually involves a surgical oncologist, a clinical oncologist, a pathologist, and, when necessary, a clinical nutritionist, always individualized according to staging.