Lymph Node Positivity in Appendiceal Adenocarcinoma: Should Size Matter?
John V Gahagan1, Matthew D Whealon, Michael J Phelan
1Department of Surgery, University of California Irvine, Irvine, CA Department of Statistics, University of California Irvine, Irvine, CA.
Journal of the American College of Surgeons
|February 12, 2017
Summary
Appendiceal adenocarcinoma has a high rate of lymph node metastases, even in small tumors. Right hemicolectomy is recommended for all appendiceal adenocarcinomas, as appendectomy alone is insufficient.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Appendiceal adenocarcinoma management lacks clear guidelines.
- Tumor characteristics influencing lymph node metastasis are not well-defined.
Purpose of the Study:
- To determine if tumor size or depth of invasion correlates with lymph node metastases in appendiceal adenocarcinoma.
- To compare these correlations with those in colon adenocarcinoma.
Main Methods:
- Retrospective review of the National Cancer Database (2004-2013).
- Inclusion of patients with surgically resected appendiceal or colonic adenocarcinoma.
- Categorization of cases by tumor size and T stage to analyze lymph node metastasis rates.
Main Results:
- Appendiceal adenocarcinoma shows a significant correlation between larger tumor size and higher T stage (Pearson correlation=0.41).
- Lymph node metastasis rates increase with tumor size and T stage in appendiceal adenocarcinoma.
- No significant difference in lymph node metastasis rates between appendiceal and colon adenocarcinoma for tumors <3 cm or in situ/T1 stages.
Conclusions:
- Appendiceal adenocarcinoma frequently presents with lymph node metastases, regardless of tumor size.
- Tumor size should not influence the decision for hemicolectomy in appendiceal adenocarcinoma.
- Right hemicolectomy is recommended for all appendiceal adenocarcinomas due to inadequate lymph node sampling with appendectomy alone.
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