Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid 28006, Spain.
Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona 08035, Spain.
World J Gastroenterol. 2022 Apr 7;28(13):1304-1314. doi: 10.3748/wjg.v28.i13.1304.
Appendiceal neuroendocrine tumors (aNETs) are an uncommon neoplasm that is relatively indolent in most cases. They are typically diagnosed in younger patients than other neuroendocrine tumors and are often an incidental finding after an appendectomy. Although there are numerous clinical practice guidelines on management of aNETs, there is continues to be a dearth of evidence on optimal treatment. Management of these tumors is stratified according to risk of locoregional and distant metastasis. However, there is a lack of consensus regarding tumors that measure 1-2 cm. In these cases, some histopathological features such as size, tumor grade, presence of lymphovascular invasion, or mesoappendix infiltration must also be considered. Computed tomography or magnetic resonance imaging scans are recommended for evaluating the presence of additional disease, except in the case of tumors smaller than 1 cm without additional risk factors. Somatostatin receptor scintigraphy or positron emission tomography with computed tomography should be considered in cases with suspected residual or distant disease. The main point of controversy is the indication for performing a completion right hemicolectomy after an initial appendectomy, based on the risk of lymph node metastases. The main factor considered is tumor size and 2 cm is the most common threshold for indicating a colectomy. Other factors such as mesoappendix infiltration, lymphovascular invasion, or tumor grade may also be considered. On the other hand, potential complications, and decreased quality of life after a hemicolectomy as well as the lack of evidence on benefits in terms of survival must be taken into consideration. In this review, we present data regarding the current indications, outcomes, and benefits of a colectomy.
阑尾神经内分泌肿瘤（aNETs）是一种罕见的肿瘤，在大多数情况下生长缓慢。它们通常在比其他神经内分泌肿瘤更年轻的患者中被诊断出来，并且通常是阑尾切除术后的偶然发现。尽管有许多关于 aNETs 管理的临床实践指南，但关于最佳治疗方法的证据仍然不足。这些肿瘤的管理根据局部和远处转移的风险进行分层。然而，对于测量 1-2 厘米的肿瘤，目前缺乏共识。在这些情况下，一些组织病理学特征，如大小、肿瘤分级、淋巴管血管侵犯或中阑尾浸润，也必须考虑。建议进行计算机断层扫描或磁共振成像扫描以评估是否存在其他疾病，除非肿瘤小于 1 厘米且无其他危险因素。如果怀疑有残留或远处疾病，应考虑进行生长抑素受体闪烁扫描或正电子发射断层扫描与计算机断层扫描。争议的主要焦点是根据淋巴结转移的风险，在初始阑尾切除术后是否需要进行补充右半结肠切除术。主要考虑的因素是肿瘤大小，2 厘米是最常见的结肠切除术指征。其他因素，如中阑尾浸润、淋巴管血管侵犯或肿瘤分级，也可能被考虑。另一方面，必须考虑到半结肠切除术后的潜在并发症、生活质量下降以及在生存方面缺乏益处的证据。在这篇综述中，我们介绍了关于结肠切除术的当前适应证、结果和益处的数据。
