Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy.

Data de publicació: 07/04/2022

Autors de IIS La Fe

• María Isabel Del Olmo García

  Autor

Autors aliens a IIS La Fe

• Muñoz de Nova JL
• Hernando, Jorge
• Sampedro Núñez M
• Vázquez Benítez GT
• Triviño Ibáñez EM
• Barriuso, Jorge
• Capdevila, Jaume
• Martin-Perez, Elena

Grups d'Investigació

• Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

  Leader

  Juan Francisco Merino Torres

Abstract

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.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

Keywords

• Appendiceal neoplasms; Carcinoid tumor; Colectomy; Neoplasm grading; Neuroendocrine tumors; Treatment outcome