Köhler F, Rosenfeldt M, Matthes N, Kastner C, Germer C-T, Wiegering A
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland.
Pathologisches Institut, Universität Würzburg, Würzburg, Deutschland.
Chirurg. 2019 Mar;90(3):194-201. doi: 10.1007/s00104-018-0768-1.
Tumors of the appendix are not a uniform group but differ significantly in terms of their origin/histology and metastatic behavior. Furthermore, tumors of the appendix are often diagnosed as incidental findings after appendectomy for acute appendicitis. A subgroup of these neoplasms are low-grade appendiceal mucinous neoplasms (LAMN). These are mucus-forming tumors of the appendiceal lumen, which can lead to rupture of the appendix and seeding into the abdominal cavity. Therefore LAMN are considered precursors of pseudomyxoma peritonei (PMP). It is essential to clearly differentiate the subgroups of LAMN as well as the resection status. According to this it is determined whether (radical) appendectomy is a sufficient therapy or further treatment, such as ileocecal resection with hyperthermic intraperitoneal chemotherapy (HIPEC) or cytoreductive surgery (CRS) is necessary. There is no standardized concept regarding the follow-up after resection of LAMN. Generally, it is recommended to perform a computed tomography (CT) scan of the abdomen and determination of tumor markers 6 months postoperatively and then once a year. A recommendation regarding the duration of follow-up is difficult as there are case reports in which PMP has occurred more than 15 years after removal of LAMN.
阑尾肿瘤并非一类统一的肿瘤，而是在起源/组织学和转移行为方面存在显著差异。此外，阑尾肿瘤常在因急性阑尾炎行阑尾切除术后被偶然发现。这些肿瘤中的一个亚组是低级别阑尾黏液性肿瘤（LAMN）。它们是阑尾腔内形成黏液的肿瘤，可导致阑尾破裂并播散至腹腔。因此，LAMN被认为是腹膜假黏液瘤（PMP）的前驱病变。明确区分LAMN的亚组以及切除状态至关重要。据此确定单纯（根治性）阑尾切除术是否为充分的治疗手段，抑或是否需要进一步治疗，如行回盲部切除联合腹腔内热灌注化疗（HIPEC）或减瘤手术（CRS）。对于LAMN切除术后的随访，尚无标准化的方案。一般而言，建议术后6个月进行腹部计算机断层扫描（CT）及肿瘤标志物检测，之后每年检测一次。由于有病例报告显示，PMP在LAMN切除术后15年以上才出现，因此很难给出关于随访时长的建议。
