Endocrine Unit, Department of Pathophysiology, Laiko University Hospital, Athens Medical School, Mikras Asias 75, 115 27, Athens, Greece.
J Endocrinol Invest. 2011 Apr;34(4):255-9. doi: 10.1007/BF03347081. Epub 2010 Oct 8.
Appendiceal carcinoids (AC) are usually adequately treated by appendectomy. The European Neuroendocrine Tumours Society (ENETS) has recently reconsidered the previous pathologic criteria to identify patients at high risk of extra-appendiceal disease, who are thought to require right hemicolectomy (RHC).
The aim of this retrospective, observational study was to evaluate previous and currently introduced criteria, in identifying patients with AC in whom RHC is justified.
Twelve patients who underwent RHC for AC were retrospectively identified. Demographic and follow-up data were collected and appendectomy specimens were reviewed for the presence of indications leading to RHC defined as: tumor diameter ≥2 cm, tumor location at the base, mesoappendiceal extension, mitotic index Ki-67≥2%. RHC specimens were examined to identify evidence of extra-appendiceal disease, remaining and/or metastatic disease.
Four patients fulfilled two criteria and 8 one criterion for RHC. Two patients had tumors ≥2.0 cm, 5 located at the base, 8 invading the mesoappendix and periappendiceal fat; Ki-67 PI was 1% in all cases measured except one, in which it was 3%. Post-RHC, 3 patients (25%) had extra-appendiceal disease (no residual disease was identified in surgical margins); 1 had tumor at the colon specimen and 2 had lymph node metastasis. All 3 patients fulfilled only one pathologic criterion; 1 had tumor mesoappendiceal extension and 2 tumor location at the base of the appendix.
Applying previous and currently introduced pathologic criteria, 25% of high-risk patients with AC had identifiable extra-appendiceal disease following RHC that might be not detected following the recently introduced ENETS criteria.
阑尾类癌（AC）通常通过阑尾切除术得到充分治疗。欧洲神经内分泌肿瘤学会（ENETS）最近重新考虑了以前的病理标准，以确定被认为需要右半结肠切除术（RHC）的具有高风险的阑尾外疾病的患者。
本回顾性观察性研究的目的是评估以前和目前引入的标准，以确定需要 RHC 的 AC 患者。
回顾性确定了 12 例因 AC 而行 RHC 的患者。收集了人口统计学和随访数据，并对阑尾切除术标本进行了检查，以确定导致 RHC 的指征，这些指征定义为：肿瘤直径≥2cm、肿瘤位于基底、阑尾系膜延伸、有丝分裂指数 Ki-67≥2%。检查 RHC 标本以确定阑尾外疾病、残留和/或转移性疾病的证据。
4 例患者符合 2 项 RHC 标准，8 例患者符合 1 项 RHC 标准。2 例患者的肿瘤直径≥2.0cm，5 例位于基底，8 例侵犯阑尾系膜和阑尾周围脂肪；除了一个病例的 Ki-67 PI 为 3%，其余病例均为 1%。RHC 后，3 例（25%）患者存在阑尾外疾病（手术切缘未发现残留疾病）；1 例结肠标本有肿瘤，2 例有淋巴结转移。所有 3 例患者仅符合 1 项病理标准；1 例有阑尾系膜延伸肿瘤，2 例有阑尾基底肿瘤。
应用以前和目前引入的病理标准，25%的具有高风险的 AC 患者在接受 RHC 后可发现可识别的阑尾外疾病，而这些疾病可能无法通过最近引入的 ENETS 标准检测到。
