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Surgical management of appendiceal mucinous neoplasm: Is appendectomy sufficient?
Stephanie Young1, Stefanie K Sueda1, Mayo Hotta1
1Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Background And Objectives:
Due to the rarity of appendiceal mucinous neoplasms (AMNs), there are few established treatment guidelines. The clinical course varies from incidental detection to progressive spread with pseudomyxoma peritonei (PMP). This study investigated the extent of resection on the prognosis and outcomes of AMNs.
Methods:
This multicenter retrospective study evaluated patients with AMN who underwent surgery between 4/2006 to 9/2017. Primary endpoints included overall survival (OS) and disease-specific survival (DSS). Secondary endpoints included PMP incidence and treatment with cytoreductive surgery (CRS).
Results:
Of the 138 patients with AMN, 70 patients (54%) underwent appendectomy, 26 (19%) cecectomy, and 37 (27%) right hemicolectomy. The median age was 59.7 years and 57 patients (41%) were male. Males were less likely to undergo cecectomy (P = .03). Rupture rates, tumor characteristics, and incidence of PMP were similar across surgery groups. Median follow-up was 61.3 months. Five-year OS and DSS for the total cohort were 94.9% and 98.6%, respectively, and remained similar across all surgery groups. CRS patients were more likely to undergo right hemicolectomy with no difference in survival by surgery type (P = .03).
Conclusions:
Patients with AMN have a good overall prognosis and there may be minimal benefit to performing extended surgical resection in these patients.
Insights
Appendiceal mucinous neoplasms (AMNs) have a good prognosis. Extended surgical resection may offer minimal benefit, as survival rates were similar across different surgical approaches for AMN patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Appendiceal mucinous neoplasms (AMNs) are rare, lacking established treatment guidelines.
- Clinical presentation varies from incidental findings to pseudomyxoma peritonei (PMP).
Purpose of the Study:
- To investigate the impact of surgical resection extent on prognosis and outcomes in AMN patients.
Main Methods:
- Multicenter retrospective study of 138 AMN patients undergoing surgery (2006-2017).
- Primary endpoints: overall survival (OS) and disease-specific survival (DSS).
- Secondary endpoints: PMP incidence and cytoreductive surgery (CRS) treatment.
Main Results:
- Appendectomy, cecectomy, and right hemicolectomy were performed in 54%, 19%, and 27% of patients, respectively.
- Five-year OS and DSS were high (94.9% and 98.6%) and similar across all surgical groups.
- No significant difference in survival was observed based on the extent of surgical resection.
Conclusions:
- AMN patients generally have a favorable prognosis.
- Extended surgical resection may not significantly improve outcomes for AMNs.
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