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



Alabraba, Edward, Pritchard, David Mark ORCID: 0000-0001-7971-3561, Griffin, Rebecca ORCID: 0000-0003-4521-948X, Diaz-Nieto, Rafael, Banks, Melissa, Cuthbertson, Daniel James ORCID: 0000-0002-6128-0822 and Fenwick, Stephen
(2020) The impact of lymph node metastases and right hemicolectomy on outcomes in appendiceal neuroendocrine tumours (aNETs). Eur J Surg Oncol.

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: Appendiceal, Appendix, Carcinoids, Neuroendocrine tumours
Depositing User: Symplectic Admin
Date Deposited: 13 Oct 2020 09:32
Last Modified: 11 Jun 2022 02:14
DOI: 10.1016/j.ejso.2020.09.012
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3104083