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Appendiceal Neuroendocrine Tumors: Does Colon Resection Improve Outcomes?
Angelena Crown1,2, Vlad V Simianu1,2, Hagen Kennecke1
1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Background:
Appendiceal neuroendocrine tumors (A-NETs) are rare neoplasms of the GI tract. They are typically managed according to tumor size; however, the impact of surgical strategy on the short- and long-term outcomes is unknown.
Methods:
All patients who underwent resection of A-NET at 8 institutions from 2000 to 2016 were analyzed retrospectively. Patient clinicopathologic features and outcomes were stratified according to resection type.
Results:
Of 61 patients identified with A-NET, mean age of presentation was 44.7 ± 16.0 years and patients were predominantly Caucasian (77%) and female (56%). Mean tumor size was 1.2 ± 1.3 cm with a median of 0.8 cm. Thirty-one patients (51%) underwent appendectomy and 30 (49%) underwent colonic resection. The appendectomy group had more T1 tumors (87% vs 42%, p < 0.01) than the colon resection group. Of patients in the colon resection group, 27% had positive lymph nodes and 3% had M1 disease. R0 resections were achieved in 90% of appendectomy patients and 97% of colon resection patients. Complications occurred with a higher frequency in the colon resection group (30%) compared with those in the appendectomy group (6%, p = 0.02). The colon resection group also had a longer length of stay, higher average blood loss, and longer average OR time. Median RFS and OS were similar between groups.
Conclusion:
A-NET RFS and OS are equivalent regardless of surgical strategy. Formal colon resection is associated with increased length of stay, OR time, higher blood loss, and more complications. Further study is warranted to identify patients that are likely to benefit from more aggressive surgery.
Insights
Surgical strategy for appendiceal neuroendocrine tumors (A-NETs) does not impact recurrence-free survival or overall survival. Formal colon resection leads to more complications and longer hospital stays than appendectomy for A-NETs.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Appendiceal neuroendocrine tumors (A-NETs) are rare gastrointestinal neoplasms.
- Current management of A-NETs primarily relies on tumor size, with limited understanding of surgical strategy's impact on outcomes.
Purpose of the Study:
- To evaluate the impact of surgical resection strategy on short- and long-term outcomes for appendiceal neuroendocrine tumors (A-NETs).
Main Methods:
- Retrospective analysis of 61 patients with A-NET undergoing resection across 8 institutions (2000-2016).
- Clinicopathologic features and outcomes were stratified based on surgical approach: appendectomy versus formal colonic resection.
Main Results:
- Appendectomy was performed in 51% of patients, colonic resection in 49%.
- The colonic resection group had a higher incidence of positive lymph nodes (27%) and advanced disease (M1, 3%).
- Complications (30% vs 6%, p=0.02), length of stay, blood loss, and operative time were significantly higher in the colonic resection group, despite similar R0 resection rates (90% vs 97%) and outcomes (RFS, OS).
Conclusions:
- Recurrence-free survival (RFS) and overall survival (OS) for A-NETs are comparable irrespective of surgical approach.
- Formal colonic resection is associated with increased morbidity and resource utilization compared to appendectomy.
- Further research is needed to identify specific patient subgroups who may benefit from more aggressive surgical interventions.
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