The impact of lymph node metastases and right hemicolectomy on outcomes in appendiceal neuroendocrine tumours (aNETs)

Alabraba, Edward; Pritchard, David M.; Griffin, Rebecca; Díaz-Nieto, Rafael; Banks, Melissa; Cuthbertson, Daniel J; Fenwick, Stephen

doi:10.1016/j.ejso.2020.09.012

Cited by 12 publications

(50 citation statements)

References 29 publications

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“…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 ].…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…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 ]. Although the indication is most likely a continuum, it has been suggested that 2 cm may be the optimal cut-off point for presence of LNM[ 1 ]. Current guidelines recommend this size for considering a CRH after an appendectomy and to consider CRH for tumors from 1 to 2 cm when other risk factors are present.…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…There is controversy in the literature regarding its prognostic relevance. Some studies have found no effects on the recurrence rate[ 33 ] or presence of LNM[ 1 , 8 ], while others suggest that the disease behaves more aggressively in these patients[ 17 , 31 ]. A recent publication found that presence of mesoappendix invasion entails a higher risk of LNM and suggests an optimal cut-off point of 1 mm for indicating a CRH, which is substantially smaller than what has been suggested in previous reports[ 28 ].…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…It could be particularly relevant in patients with tumors < 2 cm, in whom it could reflect a metastatic potential similar to tumors measuring > 2 cm[ 5 , 34 ]. On the contrary, some studies have not described a higher LNM rate, but the low incidence of this finding could limit statistical significance[ 1 , 8 ]. Perineural invasion has been reported in 18% of patients[ 8 ], but there is no data to suggest more aggressive disease when it is present[ 32 ].…”

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

“…More than 80% of appendiceal neuroendocrine tumors (aNETs) are diagnosed incidentally in appendectomy specimens and are found in approximately 0.5% to 1% of all appendectomies[ 1 ]. These neoplasms have several characteristic features that differ from other gastroenteropancreatic neuroendocrine tumors (GEP-NETs).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

Section: Indications In the Literature For A Completion Right Colectomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

Nova¹,

Hernando²,

Núñez³

et al. 2022

WJG

View full text Add to dashboard Cite

show abstract

Surgical Treatment of Neuroendocrine Tumors of the Terminal Ileum or Cecum: Ileocecectomy Versus Right Hemicolectomy

Lopez‐Aguiar

Poultsides

et al. 2022

Journal of Gastrointestinal Surgery

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An Update on Appendiceal Neuroendocrine Tumors

Andrini

Alberici

Ricci

et al. 2023

Curr. Treat. Options in Oncol.

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The mainstay of appendiceal neuroendocrine neoplasm (aNEN) treatment is surgery, based on simple appendectomy or right-sided hemicolectomy with lymphadenectomy (RHC). The majority of aNENs are adequately treated with appendectomy, but current guidelines have poor accuracy in terms of selecting patients requiring RHC, especially in aNENs 1–2 cm in size. Simple appendectomy is curative for appendiceal NETs (G1–G2) < 1 cm (if the resection status is R0), whereas RHC with lymph node dissection is recommended in tumors ≥ 2 cm in diameter, based on the high risk of nodal metastases in these cases. The clinical management of aNENs 1–2 cm in size is more controversial because lymph node or distant metastases are uncommon but possible. In our opinion, patients with tumor size > 15 mm or with grading G2 (according to WHO 2010) and/or lympho-vascular invasion should be referred for radicalization with RHC. However, decision-making in these cases should include discussion within a multidisciplinary tumor board at referral centers with the aim of offering each patient a tailored treatment, also considering that relatively young patients with long-life expectancy represent the majority of cases.

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The impact of lymph node metastases and right hemicolectomy on outcomes in appendiceal neuroendocrine tumours (aNETs)

Cited by 12 publications

References 29 publications

Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

Surgical Treatment of Neuroendocrine Tumors of the Terminal Ileum or Cecum: Ileocecectomy Versus Right Hemicolectomy

An Update on Appendiceal Neuroendocrine Tumors

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