An Update on Appendiceal Neuroendocrine Tumors.
Elisa AndriniGiuseppe LambertiLaura AlbericiClaudio RicciDavide CampanaPublished in: Current treatment options in oncology (2023)
The mainstay of appendiceal neuroendocrine neoplasm (aNEN) treatment is surgery, based on simple appendectomy or right-sided hemicolectomy with lymphadenectomy (RHC). The majority of aNENs are adequately treated with appendectomy, but current guidelines have poor accuracy in terms of selecting patients requiring RHC, especially in aNENs 1-2 cm in size. Simple appendectomy is curative for appendiceal NETs (G1-G2) < 1 cm (if the resection status is R0), whereas RHC with lymph node dissection is recommended in tumors ≥ 2 cm in diameter, based on the high risk of nodal metastases in these cases. The clinical management of aNENs 1-2 cm in size is more controversial because lymph node or distant metastases are uncommon but possible. In our opinion, patients with tumor size > 15 mm or with grading G2 (according to WHO 2010) and/or lympho-vascular invasion should be referred for radicalization with RHC. However, decision-making in these cases should include discussion within a multidisciplinary tumor board at referral centers with the aim of offering each patient a tailored treatment, also considering that relatively young patients with long-life expectancy represent the majority of cases.
Keyphrases
- lymph node
- low grade
- sentinel lymph node
- neuroendocrine tumors
- end stage renal disease
- newly diagnosed
- neoadjuvant chemotherapy
- rectal cancer
- primary care
- early stage
- minimally invasive
- robot assisted
- squamous cell carcinoma
- case report
- lymph node metastasis
- acute coronary syndrome
- percutaneous coronary intervention
- peritoneal dialysis
- coronary artery bypass
- patient reported outcomes
- locally advanced
- high grade
- quality improvement
- atrial fibrillation