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Appendectomy and Hemicolectomy Equivalent in Appendiceal Neuroendocrine Tumors
The approach to surgical management of incidentally found appendiceal neuroendocrine tumors (NETs) is right hemicolectomy when tumors are >2 cm in size. For tumors 1–2 cm in size, the appropriate surgical approach is not clearly defined.
Investigators analyzed a large, retrospective surgical database from 40 hospitals in 15 European countries for patients treated between 2000 and 2010. Of 278 patients with an appendiceal neuroendocrine tumor 1–2 cm in size confirmed on central histopathologic review, 59% underwent complete surgical resection with appendectomy alone and 41% underwent appendectomy with right hemicolectomy. Median age at surgery was 36, and most patients (60%) were female. Lymph node metastases were found in 20% of patients who underwent hemicolectomy.
There was no significant difference in survival at 5, 10, 15, or 20 years between patients undergoing appendectomy and those undergoing hemicolectomy (96% vs. 94% at 5 years; 92% vs. 91% at 10 years; 87% in both groups at 15 years; and 80% vs. 87% at 20 years). At a median follow-up of 13 years, overall survival was similar in the two groups (hazard ratio, 0.88; P=0.71). In the subset of patients with incidentally found appendiceal tumors excluding those who underwent surgery for potential other associated tumors, there still was no difference in overall survival between treatment groups (HR, 0.81; P=0.78). Other pathologic risk factors, including presence of lymph node metastases, had no impact on survival. No tumor relapses or tumor-related deaths were observed during follow-up.
This important series supports appendectomy alone for patients with the finding of a 1–2 cm NET at surgery. Hemicolectomy did not improve survival. The diagnosis and resection of lymph node metastases had no effect on survival, indicating that they are not clinically relevant.
Nesti C et al.
Title: Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: A retrospective, Europe-wide, pooled cohort study.
Source: Lancet Oncol 2023 Feb ; [e-pub]. (Abstract/FREE Full Text)