Neuroendocrine neoplasms of the appendix: Characterization of 335 patients referred to the Copenhagen NET Center of Excellence

Holmager, Pernille; Willemoe, Gro Linno; Nielsen, Kirstine; Grøndahl, Veronica; Klose, Marianne; Andreassen, Mikkel; Langer, Seppo W.; Hansen, Carsten P.; Kjær, Andreas; Federspiel, Birgitte; Knigge, Ulrich

doi:10.1016/j.ejso.2021.02.005

Cited by 23 publications

(60 citation statements)

References 22 publications

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“…Right-sided hemicolectomy is not indicated for R0 resected tumours <1cm regardless of the presence of risk factors. Risk factors for malignant disease include invasion of mesoappendix >3 mm, vascular invasion, lymphatic invasion and Ki-67 > 10% [47]. R0 resected tumours 1-2 cm with the presence of two or more risk factors is an indication for right-sided hemicolectomy with lymph node dissection [48].…”

Section: Clinical Presentationmentioning

confidence: 99%

Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

et al. 2021

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Background: The diagnostic work-up and treatment of patients with gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN) has undergone major advances and new methods are introduced. Furthermore, an update of the WHO classification has resulted in a new nomenclature for GEP-NEN that is implemented in the clinic. Aim: These Nordic guidelines summarise the Nordic Neuroendocrine Tumour Group's current view on how to diagnose and treat GEP-NEN patients and aims to be useful in the daily practice for clinicians.

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Section: Clinical Presentationmentioning

confidence: 99%

Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

et al. 2021

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“…After a CRH, residual disease or lymph node involvement is present in 0% to 40% of cases[ 2 , 8 , 28 ]. A recent review by Webb et al [ 11 ] of patients in the National Cancer Database treated with surgery found that, unlike other types of appendiceal neoplasms, in aNET, the presence of regional LNM does not reduce overall survival.…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…Tumor size: Some recent studies suggest that size is the main factor related to the occurrence of LNM[ 1 , 8 , 15 , 29 , 30 ]. As stated above, controversy arises in aNETs that are greater than 2 cm and those from 1 to 2 cm, which represent from 3% to 7% and from 20% to 25% of cases, respectively[ 8 , 28 ]. The 10-year survival rate according to size is 100%, 92%, and 91% for < 1 cm, 1 to 2 cm, and > 2 cm, respectively[ 31 ].…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…In a recent meta-analysis, the rate of LNM was 12.1%, 38.5%, and 61% for tumors measuring < 1 cm, 1 to 2 cm, and > 2 cm, respectively[ 32 ]. A reduction in the cut-off point for a colectomy from 15 mm to 13 mm regardless of other features has been proposed due to the possible presence of LNM, but no studies have found any benefit in terms of recurrence or survival[ 5 , 28 ].…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…Mesoappendix invasion: Its incidence ranges from 23% to 39%[ 5 , 8 , 28 ]. There is controversy in the literature regarding its prognostic relevance.…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

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Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

Nova¹,

Hernando²,

Núñez³

et al. 2022

WJG

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Appendiceal neuroendocrine tumors (aNETs) are an uncommon neoplasm that is relatively indolent in most cases. They are typically diagnosed in younger patients than other neuroendocrine tumors and are often an incidental finding after an appendectomy. Although there are numerous clinical practice guidelines on management of aNETs, there is continues to be a dearth of evidence on optimal treatment. Management of these tumors is stratified according to risk of locoregional and distant metastasis. However, there is a lack of consensus regarding tumors that measure 1-2 cm. In these cases, some histopathological features such as size, tumor grade, presence of lymphovascular invasion, or mesoappendix infiltration must also be considered. Computed tomography or magnetic resonance imaging scans are recommended for evaluating the presence of additional disease, except in the case of tumors smaller than 1 cm without additional risk factors. Somatostatin receptor scintigraphy or positron emission tomography with computed tomography should be considered in cases with suspected residual or distant disease. The main point of controversy is the indication for performing a completion right hemicolectomy after an initial appendectomy, based on the risk of lymph node metastases. The main factor considered is tumor size and 2 cm is the most common threshold for indicating a colectomy. Other factors such as mesoappendix infiltration, lymphovascular invasion, or tumor grade may also be considered. On the other hand, potential complications, and decreased quality of life after a hemicolectomy as well as the lack of evidence on benefits in terms of survival must be taken into consideration. In this review, we present data regarding the current indications, outcomes, and benefits of a colectomy.

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Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases

Tamura

Ueki

Nakayama

et al. 2023

Langenbecks Arch Surg

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Purpose: A diagnostic and treatment strategy for appendiceal tumors (ATs) has not been established. We aimed to evaluate our treatment strategy for ATs including laparoscopic surgery (LS) and to identify preoperative malignancy predictors.Methods: A total of 51 patients were retrospectively reviewed. Data including tumor markers and imaging ndings were compared between carcinoma and non-carcinoma patients. Validity of planned operation was evaluated based on pathological diagnosis.Results: Twenty-ve patients were diagnosed with carcinoma, 13 with low-grade mucinous neoplasm, and 13 with other diseases. Symptoms were more commonly present in carcinoma patients than in non-carcinoma patients (68.0% vs. 23.1%, p=0.001). Elevated CEA and CA19-9 were more frequently observed in carcinoma patients than in non-carcinoma patients (p<0.01 and p=0.04, respectively). Five carcinoma patients had malignancy on biopsy, compared with zero non-carcinoma patients. Signi cant differences were noted in the percentages of carcinoma and non-carcinoma patients with solid enhanced mass (41.7% vs. 0%, p<0.001) and tumor wall irregularity (16.7% vs. 0%, p=0.03) on imaging. Although the sensitivity was not high, the speci city and positive predictive value of these ndings were 100%. Forty-two patients (82.4%) underwent LS as minimally invasive exploratory tool and/or radical operation, of whom 2 were converted to open surgery for invasion of adjacent organ. None of the patients had intraoperative complications or postoperative mortality.Conclusion: Clinical symptoms, elevated tumor markers, and worrisome features of solid enhanced mass and tumor wall irregularity on imaging can be malignancy predictors. For management of AT patients, LS is feasible and useful for diagnosis and treatment.Recently, the number of procedures involving laparoscopic surgery (LS) has been increasing in a variety of surgical elds [13]. Several studies reported that LS can be used for safe and radical resection of CRC and appendiceal tumors [14]. LS may have advantages of not only reduced invasiveness but also utility as an intraoperative diagnostic tool for cases without a de nite preoperative diagnosis.The aim of this study was to determine malignancy predictors using clinical data and preoperative imaging ndings for patients with appendiceal tumors, and to evaluate the validity of performed operations based on the preoperative and postoperative diagnosis. We also discuss the usefulness of LS for appendiceal tumors and review our surgical treatment strategy for appendiceal tumors. Methods

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Neuroendocrine neoplasms of the appendix: Characterization of 335 patients referred to the Copenhagen NET Center of Excellence

Cited by 23 publications

References 22 publications

Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases

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