Management of Appendiceal Neuroendocrine Tumors: Metastatic Potential of Small Tumors.

Autor: Landry JP; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA. jlan10@lsuhsc.edu., Voros BA; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.; The New Orleans Louisiana Neuroendocrine Tumor Specialists, New Orleans, LA, USA.; Neuroendocrine Tumor Clinic, Ochsner Medical Center, Kenner, LA, USA., Ramirez RA; The New Orleans Louisiana Neuroendocrine Tumor Specialists, New Orleans, LA, USA.; Neuroendocrine Tumor Clinic, Ochsner Medical Center, Kenner, LA, USA., Boudreaux JP; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.; The New Orleans Louisiana Neuroendocrine Tumor Specialists, New Orleans, LA, USA.; Neuroendocrine Tumor Clinic, Ochsner Medical Center, Kenner, LA, USA., Woltering EA; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.; The New Orleans Louisiana Neuroendocrine Tumor Specialists, New Orleans, LA, USA.; Neuroendocrine Tumor Clinic, Ochsner Medical Center, Kenner, LA, USA., Thiagarajan R; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.; The New Orleans Louisiana Neuroendocrine Tumor Specialists, New Orleans, LA, USA.; Neuroendocrine Tumor Clinic, Ochsner Medical Center, Kenner, LA, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2021 Feb; Vol. 28 (2), pp. 751-757. Date of Electronic Publication: 2020 Jul 20.
DOI: 10.1245/s10434-020-08748-4
Abstrakt: Background: Appendiceal neuroendocrine tumors (ANETs) are rare neoplasms usually discovered incidentally during appendectomy. ANETs < 2 cm were thought to have no metastatic potential, and this dogma has driven management. Our aim is to evaluate the metastatic potential of ANETs < 2 cm.
Patients and Methods: A retrospective review was performed in a series of patients with ANETs who presented to our tertiary referral center from 1998 to 2019. Demographics, tumor characteristics, treatment, and clinical outcomes were evaluated.
Results: In total, 114 patients were included. Median follow-up was 3.3 years (range, 21 days-15 years). At last follow-up, 34 (30%) patients had positive regional lymph nodes and 20 (18%) patients had metastatic disease. Of the 20 patients with metastatic disease, 11 (55%) had primary ANETs < 2 cm. Patient age > 40 years at diagnosis and ANETs with serosal invasion, lymphovascular invasion, intermediate tumor grade, or positive lymph nodes were features significantly more likely to present with metastatic disease. We found no difference in the rate of lymph node positivity, metastatic disease, or overall survival when patients were stratified by tumor size or type of resection (appendectomy vs. right hemicolectomy). On multivariate analysis, patients with metastatic disease at diagnosis had worse overall survival (HR = 24.4, p = 0.008).
Conclusions: In our cohort, tumor size was not a significant risk factor for metastatic disease or worse outcome as many patients with ANETs < 2 cm developed metastatic disease. Appendectomy alone was sufficient surgical management for most ANETs. Patients with risk factors for metastatic disease, regardless of primary ANET size, should be evaluated thoroughly and counseled for further management and surveillance.
Databáze: MEDLINE
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