Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, UK.
Division of Cancer Sciences, University of Manchester, UK.
Eur J Surg Oncol. 2024 Oct;50(10):108600. doi: 10.1016/j.ejso.2024.108600. Epub 2024 Aug 10.
Low-grade appendiceal mucinous neoplasms (LAMNs) are classified as non-perforated (pTis, pT3) or perforated (pT4), and considered precursors of pseudomyxoma peritonei (PMP). This study aims to quantify the risk of developing PMP from pTis and pT3 LAMNs.
Retrospective analysis of a prospectively collected database identified LAMN patients referred to a specialist centre from 2004 to 2019. pT4 LAMNs and other appendix tumours were excluded. All patients had specialist review of their pathology, operation note, and a CT scan (at least 6 weeks post-operatively). Surveillance CTs were then performed at 6, 12, 24, 36, 48, & 60 months, with tumour markers (CEA, CA19-9, CA125).
193 pT3/pTis LAMN patients were included (pTis = 153, pT3 = 40). Median follow-up = 6.45 (3.91-22.13) years, M:F ratio = 1:1.57, and median age = 57 (23-83) years. Initial surgery included: appendicectomy (67 %), appendicectomy + visceral resection (6 %), and right hemicolectomy (27 %). R1 resections were identified in 5/193 patients (2.5 %). 3 R patients underwent re-operation (2 caecal pole excision and 1 ileocecectomy), none of which had residual tumour. 8/193 patients (4 %) were lost to follow up. None of the remaining 185 developed PMP.
This is the largest reported series of pTis/pT3 LAMNs with standardised follow-up in the literature. LAMNs correctly classified as pT3/pTis (after careful specialist review of pathology, operation note, and a baseline post-operative CT) have negligible risk of developing PMP and should have low intensity surveillance. If completely excised, further surgery is not indicated. R1 resections should be considered on an individual basis at a specialist centre.
低级别阑尾黏液性肿瘤（LAMN）分为非穿孔型（pTis、pT3）或穿孔型（pT4），被认为是假性黏液瘤腹膜的前兆（PMP）。本研究旨在量化 pTis 和 pT3 LAMN 发展为 PMP 的风险。
对 2004 年至 2019 年期间从一个专门中心转诊的 LAMN 患者进行前瞻性收集数据库的回顾性分析。排除了 pT4 LAMN 和其他阑尾肿瘤。所有患者均由专家对其病理、手术记录和 CT 扫描（至少术后 6 周）进行了复查。然后在 6、12、24、36、48 和 60 个月进行 CT 监测，并进行肿瘤标志物（CEA、CA19-9、CA125）检测。
共纳入 193 例 pT3/pTis LAMN 患者（pTis=153，pT3=40）。中位随访时间为 6.45 年（3.91-22.13 年），男女比例为 1:1.57，中位年龄为 57 岁（23-83 岁）。初始手术包括阑尾切除术（67%）、阑尾切除术+内脏切除术（6%）和右半结肠切除术（27%）。在 193 例患者中，有 5 例（2.5%）为 R1 切除。3 例 R 患者行再次手术（2 例盲肠切除术和 1 例回盲肠切除术），均无残留肿瘤。193 例患者中有 8 例（4%）失访。其余 185 例患者均未发生 PMP。
这是文献中报道的最大系列 pTis/pT3 LAMN 病例，具有标准化的随访。经过病理、手术记录和基线术后 CT 的专家仔细复查后，正确分类为 pT3/pTis 的 LAMN 发生 PMP 的风险极小，应进行低强度监测。如果完全切除，不需要进一步手术。R1 切除应在专门中心根据个体情况考虑。
