Department of Experimental, Diagnostic & Specialty Medicine (DIMES), University of Bologna, 40138, Bologna, Italy.
Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via P. Albertoni, 15, 40138, Bologna, Italy.
Curr Treat Options Oncol. 2023 Jul;24(7):742-756. doi: 10.1007/s11864-023-01093-0. Epub 2023 May 4.
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.
阑尾神经内分泌肿瘤（aNEN）的主要治疗方法是手术，根据简单的阑尾切除术或右侧半结肠切除术加淋巴结清扫术（RHC）进行。大多数 aNEN 可以通过阑尾切除术得到充分治疗，但目前的指南在选择需要 RHC 的患者方面准确性较差，尤其是在 1-2cm 大小的 aNEN 中。对于直径小于 1cm 的阑尾神经内分泌瘤（G1-G2）（如果切除状态为 R0），单纯阑尾切除术是有效的，而对于直径大于 2cm 的肿瘤，建议进行 RHC 加淋巴结清扫术，因为这些情况下淋巴结转移的风险较高。1-2cm 大小的 aNEN 的临床管理更具争议性，因为淋巴结或远处转移不常见但可能发生。在我们看来，肿瘤大小>15mm 或分级为 G2（根据 2010 年 WHO 标准）和/或淋巴管血管侵犯的患者应进行 RHC 根治性治疗。然而，在这些情况下做出决策应包括在转诊中心的多学科肿瘤委员会内进行讨论，目的是为每位患者提供量身定制的治疗方案，同时也要考虑到具有较长预期寿命的相对年轻患者占大多数。
