Wächter Sabine, Panidis Dimitrios, Jesinghaus Moritz, Rinke Anja, Heinzel-Gutenbrunner Monika, Maurer Elisabeth, Bartsch Detlef K
Department of Visceral, Thoracic and Vascular Surgery, Philipps-Universität Marburg, Baldingerstraße, Marburg, 35043, Germany.
Institute of Pathology, Philipps-Universität Marburg, Marburg, Baldingerstraße, 35043, Germany.
Langenbecks Arch Surg. 2025 Jan 20;410(1):46. doi: 10.1007/s00423-024-03603-6.
Neuroendocrine neoplasms of the appendix (aNET) are rare tumors that are often diagnosed by pathology as an incidental finding after appendectomy for acute appendicitis. Several guidelines proposed risk criteria to indicate oncological completion surgery after appendectomy. The aim of this study was to evaluate the reliability of proposed criteria for completion surgery of aNET.
Patients with aNET treated at ENETS center of excellence Marburg between 2002 and 2022 were retrieved from a prospective data base. Demographic data, histopathological findings, including formerly proposed criteria to indicate oncological completion surgery, histological results of the completion resection and disease-free survival were evaluated.
82 patients with a median age of 35 (range 8-82) years were analysed. 72 (88%) patients underwent an emergency appendectomy because of acute appendicitis. 11 (13%) patients received an ileocecal resection or right hemicolectomy. Seven (8.5%) patients had lymph node metastases and three (3.6%) patients had distant metastases at the initial operation. 27 (33%) patients underwent completion surgery by right hemicolectomy according to guideline criteria, but postoperative histology detected lymph node and distant metastases in only six (22%) and zero patients resulting in an overtreatment of 21 (75%) patients. A tumor size of > 2 cm was the only significant criterion which was associated with lymph node metastases (p < 0.05). After a median follow-up of 62 months (range 2-264) 76 (96%) of the patients in stages I to III were alive with no evidence of disease.
aNET have an excellent prognosis in stages I-III and distant metastases are rare. Formerly proposed criteria for oncological completion surgery have to be adopted and discussed for every patient, as they might result in an overtreatment in at least 75% of patients.
阑尾神经内分泌肿瘤（aNET）是罕见肿瘤，常在因急性阑尾炎行阑尾切除术后经病理检查偶然发现而确诊。多项指南提出了风险标准，以指示阑尾切除术后的肿瘤根治性手术。本研究旨在评估所提出的aNET根治性手术标准的可靠性。
从一个前瞻性数据库中检索2002年至2022年在马尔堡ENETS卓越中心接受治疗的aNET患者。评估人口统计学数据、组织病理学结果，包括先前提出的指示肿瘤根治性手术的标准、根治性切除的组织学结果和无病生存期。
分析了82例患者，中位年龄35岁（范围8 - 82岁）。72例（88%）患者因急性阑尾炎接受了急诊阑尾切除术。11例（13%）患者接受了回盲部切除术或右半结肠切除术。7例（8.5%）患者在初次手术时有淋巴结转移，3例（3.6%）患者有远处转移。27例（33%）患者根据指南标准接受了右半结肠根治性手术，但术后组织学检查仅在6例（22%）患者中检测到淋巴结转移，在0例患者中检测到远处转移，导致21例（75%）患者过度治疗。肿瘤大小>2 cm是与淋巴结转移相关的唯一显著标准（p<0.05）。中位随访62个月（范围2 - 264个月）后，I至III期的76例（96%）患者存活，无疾病证据。
aNET在I - III期预后良好，远处转移罕见。先前提出的肿瘤根治性手术标准必须针对每位患者采用并进行讨论，因为它们可能导致至少75%的患者过度治疗。
