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Appendiceal neuroendocrine tumours, when to operate?
Imogen Watt1, Luke Henry1, Jamish Gandhi1
1Auckland City Hospital, Auckland, New Zealand.
Summary
Appendix neuroendocrine tumours (ANETs) under 2 cm rarely metastasize, supporting conservative management. Right hemicolectomy (RH) is recommended for ANETs over 2 cm, while smaller tumors may be managed non-surgically.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Appendix neuroendocrine tumors (ANETs) risk varies with histopathology.
- Right hemicolectomy (RH) is standard for ANETs >2 cm; appendectomy suffices for <1 cm.
- Treatment guidelines for 1-2 cm ANETs remain unclear.
Purpose of the Study:
- Evaluate non-surgical management for well-differentiated 1-2 cm ANETs.
- Review outcomes for ANETs <1 cm and >2 cm.
- Clarify RH indications for ANETs based on size and risk factors.
Main Methods:
- Retrospective cohort study of ANETs resected via appendectomy.
- Data sourced from the New Zealand NETwork! registry (1995-2012).
- Analysis of tumor size, treatment, and follow-up outcomes.
Main Results:
- 204 ANETs analyzed: 77% <1 cm, 20% 1-2 cm, 3.4% >2 cm.
- One >2 cm ANET showed lymph node metastasis post-RH.
- No recurrences or metastases observed in 1-2 cm ANETs managed conservatively.
Conclusions:
- ANETs <2 cm generally do not metastasize.
- Support RH for ANETs >2 cm.
- Advocate for conservative management of ANETs <2 cm.
Keywords:
NETappendiceal NENappendiceal cancerappendiceal neuroendocrine neoplasmappendiceal neuroendocrine tumoursappendicitisappendixappendix cancerneuroendocrine neoplasmneuroendocrine tumour
