Necessity of posttreatment surveillance for low‐grade appendiceal mucinous neoplasms

Gupta, Aakash R.; Brajcich, Brian C.; Yang, Anthony D.; Bentrem, David J.; Merkow, Ryan P.

doi:10.1002/jso.26621

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…All of the latter were previously described as risk factors for disease progression [ 8 , 9 , 13 ], [ 14 ], [ 15 ], which would typically lead to a surgical intervention for a more extended resection with the possibility of HIPEC [ 12 ]. However, this strategy is highly controversial and is presented in total contrast to the conclusion of some scholars that surveillance post LAMN resection is unnecessary [ 23 ]. Consequently, there is still no standardized care in cases of LAMN diagnosed on surgical specimens, taking into consideration the high morbidity rate of surgical reintervention with no proven benefits in the face of possible disease progression.…”

Section: Discussionmentioning

confidence: 99%

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Mouawad,

Bardier,

Wagner

et al. 2023

Pleura and Peritoneum

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Objectives Due to the scarcity of low-grade appendiceal mucinous neoplasm (LAMN), there is an absence of systematized guidelines concerning its management, especially after incidental finding on an appendiceal specimen. In this study, we evaluate the active surveillance (AS) strategy adopted for a series of patients diagnosed with LAMN on resection specimens who were considered to have a low risk of pseudomyxoma progression. Methods Thirty patients were included between April 2014 and July 2021, with a female majority and a median follow-up period of 3.1 years. The inclusion criteria were as follows: LAMN diagnosis on appendiceal specimens, confirmed in an expert center, limited extra-appendiceal mucin resected and localized around the appendix, normal biology (CEA, CA199, CA125) and normal abdominopelvic MRI. AS included physical exam (trocar scar), biology and MRI, 6 months postoperatively, then yearly for 10 years. Results As an initial surgery, 77 % had an appendectomy as their initial intervention, 17 % had a cecectomy, and 6 % had a right colectomy. After follow-up, 87 % of patients showed no sign of disease progression by MRI, while 13 % progressed to PMP. MRI performed in the first postoperative year predicted the disease prognosis in 97 % of patients. Conclusions The AS strategy, based on MRI, is a valid option after incidental LAMN diagnosis.

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Section: Discussionmentioning

confidence: 99%

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Mouawad,

Bardier,

Wagner

et al. 2023

Pleura and Peritoneum

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“…In many cases surveillance will not be necessary; however, the risk of recurrence is never zero, as it is possible for an AMN to perforate and then re-seal, leading to a theoretical increased risk of peritoneal progression or recurrence. [134][135][136] % Agreement: First round 93%, second round 96%…”

Section: Blockmentioning

confidence: 99%

“…If final surgical margins are positive, with viable neoplastic epithelial cells at the margin (not acellular mucin alone) or there is concern for the same, repeat resection should be performed to a negative margin, although data suggests in some series that even gross resection may be adequate. [134][135][136] Historically, ileocecectomy or cecectomy have been performed, but the consensus recommendation is to perform the most conservative resection possible, such as cuff resection. Anastomosis should be avoided if possible.…”

Section: Blockmentioning

confidence: 99%

“…If final surgical margins are negative but microscopic perforation is noted, or there is microscopic extra-appendiceal mucin or neoplastic cells confined to the surface of the appendix, surveillance is indicated as described in block 11. [134][135][136] Microscopic extra-appendiceal mucin and neoplastic cells confined to the surface of the appendiceal specimen alone still constitute a negative margin. % Agreement: First round 94%, second round 98%…”

Section: Blockmentioning

confidence: 99%

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Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Turaga

2024

Preprint

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Background: Appendiceal tumors comprise a heterogeneous group of tumors which may be localized or disseminate throughout the peritoneum. Limited high quality clinical data exists and many practices have been extrapolated from colorectal cancer without validation in appendiceal cohorts. Many controversies exist regarding their treatment, and practices vary widely between centers and care settings. A national consensus update of best management practices for appendiceal malignancies was performed to better standardize care. Methods The 2018 Chicago consensus guideline was updated via modified Delphi consensus, performed over two rounds using nationally circulated surveys. Supporting evidence was evaluated using rapid systematic reviews. Key systemic therapy concepts were summarized by content experts. Results Most supporting literature consists of observational studies, but increasingly high-quality studies are becoming available to drive management. Two consensus-based pathways were generated for localized appendiceal tumors, one for epithelial mucinous neoplasms and another for appendiceal adenocarcinoma. Of 138 participants responding in the first round, 133 (96%) engaged in the second round. Over 90% consensus was achieved for all pathway blocks. Key points include minimizing intervention invasiveness where permitted by pathologic classification and margin status, and determining what margin and pathologic findings are indications for consideration of cytoreduction with or without intraperitoneal chemotherapy. Surveillance and systemic therapy recommendations are also presented. Conclusion With growing but still primarily observational evidence currently dictating care, these consensus recommendations provide expert guidance in the treatment of appendiceal tumors without peritoneal involvement.

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“…We read with interest the study entitled, 'Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms' by Gupta et al, 1 aiming to characterise posttreatment surveillance and determine the risk of recurrence of incidental low-grade appendiceal mucinous neoplasms (LAMN) following appendicectomy. This study is welcome because the risk factors of progression from LAMN to pseudomyxoma peritonei (PMP) remain poorly understood.…”

mentioning

confidence: 99%