Tiselius Catarina, Kindler Csaba, Shetye Jayant, Letocha Henry, Smedh Kenneth
Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland's Hospital, Västerås, Sweden.
Department of Surgery, Västmanland's Hospital Västerås, Västerås, Sweden.
Ann Surg Oncol. 2017 Jul;24(7):1778-1782. doi: 10.1245/s10434-016-5623-3. Epub 2017 May 4.
Low-grade appendiceal mucinous neoplasms are rare. Both classification and management vary. This study aimed to follow up on patients with a diagnosis of LAMN after primary surgery with computer tomography (CT) scans to examine the risk for the development of pseudomyxoma peritonei (PMP).
This population-based prospective study investigated patients who underwent appendectomy between 2007 and 2013 and had histology results demonstrating the presence of LAMN. The patients were followed up with a CT scan every 6 months for 2 years, until December 2015.
The study investigated 41 patients (20 females) with a median age of 65 years (range 20-87 years). The entire appendix was processed and examined, with results showing that 12 were perforated, and 3 had a positive margin. Extra-appendiceal mucin on the surface of the appendix was found in ten cases, and in two cases, extra-mucinous epithelial cells were detected. During a median follow-up period of 5.1 years (range 2-8.6 years), none of the patients experienced the development of PMP.
These data suggest that for patients with LAMN confined to the appendix, involvement of the appendectomy margin or perforation with mucin locally, even with epithelial cells, did not predict the development of PMP, and a conservative approach seems justified. No reoperation was needed, and regular follow-up evaluation with CT scans was sufficient.
低度阑尾黏液性肿瘤较为罕见。其分类和治疗方法各不相同。本研究旨在对初次手术后诊断为低度阑尾黏液性肿瘤（LAMN）的患者进行计算机断层扫描（CT）随访，以检查发生腹膜假黏液瘤（PMP）的风险。
这项基于人群的前瞻性研究调查了2007年至2013年间接受阑尾切除术且组织学结果显示存在LAMN的患者。对患者每6个月进行一次CT扫描，持续2年，直至2015年12月。
该研究调查了41例患者（20例女性），中位年龄为65岁（范围20 - 87岁）。对整个阑尾进行了处理和检查，结果显示12例阑尾穿孔，3例切缘阳性。10例在阑尾表面发现阑尾外黏液，2例检测到黏液外上皮细胞。在中位随访期5.1年（范围2 - 8.6年）内，没有患者发生PMP。
这些数据表明，对于局限于阑尾的LAMN患者，阑尾切除切缘受累或局部伴有黏液甚至上皮细胞的穿孔，并未预示PMP的发生，采用保守方法似乎是合理的。无需再次手术，定期进行CT扫描随访评估就足够了。
