Introduction Surgical management of endometrial cancer(EC) includes total hysterectomy, bilateral salpingoophorectomy and lymph node assessment. The utility of appendectomy at the time of surgical staging is unclear and not currently routine practice.

Methods We performed a single institution review of patients with clinical stage I EC undergoing total hysterectomy and surgical staging with or without appendectomy from 7/2021-9/2023. Differences in the frequencies of histology, stage, and complications were identified using Pearson’s chi-square test. One-way ANOVA determined differences in estimated blood loss and operative time.

Results 88 patients with clinical stage I EC underwent total hysterectomy and surgical staging. 19(21.6%) underwent appendectomy. The cohort was comprised of 45.5% G1, 22.6% G2, 11.6% G3, 6.7% serous, 7.9% carcinosarcoma and 5.7% mixed histology. Final pathologic stage included 64.8% IA, 15.9% IB, 2.3% II, 13.6% III and 3.4% IV. There was no difference in stage or histologic distribution between appendectomy and no-appendectomy cohorts(p=0.761 and p=0.391, respectively). There was no difference in blood loss or operative time between the cohorts(p=0.459 and p=0.832). The most common appendiceal pathologic diagnosis was fibrous obliteration(37%). There were 2(11%) patients with EC metastatic to the appendix. There were 4(21%) cases of low grade appendiceal neoplasm(LAMN).

Conclusion/Implications Appendectomy is a low-risk procedure and does not contribute to patient morbidity. Identification of appendiceal metastasis upstages the patient and changes adjuvant therapy recommendations. Management of LAMN varies based on margin status but can be an indication for long term follow-up and surgical intervention. Long term follow-up is needed to clarify the oncologic benefit of appendectomy during staging.