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Risk stratification of surveillance for low-grade appendiceal mucinous neoplasms

  • 0Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States.
Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract +

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August 29, 2024

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August 29, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

The recurrence risk for low-grade appendiceal mucinous neoplasms (LAMNs) after surgery is low. Patients with specific risk factors like right lower quadrant involvement and tumor size <2 cm require long-term surveillance for potential pseudomyxoma peritonei (PMP) recurrence.

Area Of Science

  • Gastroenterology
  • Surgical Oncology
  • Oncology

Background

  • Low-grade appendiceal mucinous neoplasms (LAMNs) can potentially progress to pseudomyxoma peritonei (PMP).
  • The incidence and risk factors for LAMN recurrence are not well-defined.
  • There is no consensus on the optimal surveillance strategy for LAMN patients.

Purpose Of The Study

  • To determine the recurrence rate and identify risk factors for LAMN after surgical resection.
  • To evaluate the necessity and duration of surveillance imaging for LAMN.

Main Methods

  • Retrospective analysis of 125 patients with LAMNs confined to the appendix and limited right lower quadrant involvement (1992-2023).
  • Assessment of recurrence risk factors using Kaplan-Meier curves and Cox proportional hazards regression.
  • Median follow-up of 51.2 months.

Main Results

  • Only 4% of patients experienced recurrence, all progressing to PMP.
  • The 5- and 10-year cumulative recurrence incidence rates were 3% and 6%, respectively.
  • LAMNs limited to the right lower quadrant and tumor size <2 cm were significant risk factors for recurrence (P < .05). Patients with these factors had a 10-year recurrence risk of 30%, versus 1% for those without.

Conclusions

  • The overall recurrence risk of LAMN after appendectomy is low.
  • Appendectomy alone is sufficient treatment for most LAMNs.
  • Long-term surveillance is recommended for high-risk patients (right lower quadrant involvement, tumor size <2 cm); others can be observed expectantly.

Keywords:

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