The impact of lymph node metastases and right hemicolectomy on outcomes in appendiceal neuroendocrine tumours (aNETs)
| Autor: | David M. Pritchard, R.C. Griffin, Edward Alabraba, Daniel J. Cuthbertson, Stephen W. Fenwick, Rafael Diaz-Nieto, Melissa Banks |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Neoplasm Residual Adolescent medicine.medical_treatment 030209 endocrinology & metabolism Disease 03 medical and health sciences Colon Ascending Young Adult 0302 clinical medicine Appendiceal Tip medicine Appendectomy Humans Stage (cooking) Lymph node Colectomy Aged Retrospective Studies Aged 80 and over business.industry Neoplasms Second Primary General Medicine Middle Aged Appendix Tumor Burden Survival Rate Neuroendocrine Tumors medicine.anatomical_structure Oncology Appendiceal Neoplasms 030220 oncology & carcinogenesis Lymphatic Metastasis Surgery Female Radiology Lymph Lymph Nodes Neoplasm Recurrence Local business Right hemicolectomy Follow-Up Studies |
| Zdroj: | Eur J Surg Oncol |
| ISSN: | 1532-2157 |
| Popis: | A bstract Introduction European Neuroendocrine Tumour Society (ENETS) recommends managing appendiceal neuroendocrine tumours (aNET) with appendicectomy and possibly completion right hemicolectomy (CRH). However, disease behaviour and survival patterns remain uncertain. Materials and methods We retrospectively assessed the impact of lymph nodes and CRH on outcomes, including survival, in all aNET patients diagnosed between 1990 and 2016. Results 102 patients (52F, 50 M), median age 39.4 (range 16.3–81.1) years, were diagnosed with aNET. Mean tumour size was 12.7 (range 1–60) mm, most sited in appendiceal tip (63%). Index surgery was appendicectomy in 79% of cases while the remainder underwent colectomy. CRH performed in 30 patients at a median 3.2 (range 1.4–9.8) months post-index surgery yielded residual disease in nine: lymph nodes (n = 8) or residual tumour (n = 1). Univariate logistic regression showed residual disease was significantly predicted by tumour size ≥2 cm (p = 0.020). Four patients declined CRH, but did not suffer relapse or reduced survival. One patient developed recurrence after 16.5 years of follow-up and another patient developed a second neuroendocrine tumour after 18.8 years follow-up. There were 5 deaths; one being aNET-related. 5-year and 10-year overall survival were 99% and 92% respectively; 5-year and 10-year relapse-free survival were 98% and 92% respectively. Only 5-year relapse-free survival was affected by ENETS stage (p = 0.002). Conclusion aNETs are indolent with very high rates of overall and relapse-free survival. Recurrence is rare, and in this series only occurred decades later, making a compelling case for selective surveillance and follow-up. The significance of positive lymph nodes and the necessity for completion right hemicolectomy remain unclear. |
| Databáze: | OpenAIRE |
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