Godfrey Elizabeth L, Mahoney Forest, Bansal Varun V, Su David G, Hanna David N, Lopez-Ramirez Felipe, Baron Ekaterina, Turaga Kiran K, Benson Al B, Cusack James, Winer Joshua H, Gunderson Craig G, Misdraji Joseph, Shah Rupen, Magge Deepa R, Solsky Ian, Eng Cathy, Eng Oliver S, Shergill Ardaman, Shen John Paul, Foote Michael B
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
Ann Surg Oncol. 2025 Jun 25. doi: 10.1245/s10434-025-17359-w.
Appendiceal tumors comprise a heterogeneous group of tumors that may be localized or disseminate throughout the peritoneum. Limited high quality clinical data exist and many practices have been extrapolated from colorectal cancer without validation in appendiceal cohorts. There are many controversies regarding the treatment of appendiceal tumors, and practices vary widely between centers and care settings. A national consensus update of best management practices for appendiceal malignancies was performed to better standardize care.
The 2018 Chicago Consensus guideline was updated through a modified Delphi consensus, performed over two rounds using nationally circulated surveys. Supporting evidence was evaluated using rapid systematic reviews. Key systemic therapy concepts were summarized by content experts.
Most supporting literature consists of observational studies, but high-quality studies increasingly are becoming available to drive management. Two consensus-based pathways were generated for localized appendiceal tumors, one for epithelial mucinous neoplasms and another for appendiceal adenocarcinoma. Of 138 participants responding in the first round, 133 (96%) engaged in the second round. Greater than 90% consensus was achieved for all pathway blocks. Key points include minimizing intervention invasiveness where permitted by pathologic classification and margin status, and determining which margin and pathologic findings are indications for consideration of cytoreduction with or without intraperitoneal chemotherapy. Surveillance and systemic therapy recommendations are also presented.
With growing but still primarily observational evidence currently dictating care, these consensus recommendations provide expert guidance in the treatment of appendiceal tumors without peritoneal involvement.
阑尾肿瘤是一组异质性肿瘤，可局限于阑尾或扩散至整个腹膜。目前高质量的临床数据有限，许多做法是从结直肠癌中推断而来，尚未在阑尾肿瘤队列中得到验证。关于阑尾肿瘤的治疗存在许多争议，不同中心和医疗环境的做法差异很大。为了更好地规范治疗，对阑尾恶性肿瘤的最佳管理实践进行了全国性的共识更新。
通过改良的德尔菲共识法对2018年芝加哥共识指南进行更新，该方法通过两轮全国范围内的调查进行。使用快速系统评价评估支持证据。关键的全身治疗概念由内容专家进行总结。
大多数支持性文献为观察性研究，但越来越多的高质量研究可用于指导管理。针对局限性阑尾肿瘤产生了两条基于共识的治疗路径，一条用于上皮性黏液性肿瘤，另一条用于阑尾腺癌。在第一轮回复的138名参与者中，133名（96%）参与了第二轮。所有路径模块均达成了超过90%的共识。要点包括在病理分类和切缘状态允许的情况下尽量减少干预的侵入性，以及确定哪些切缘和病理结果是考虑进行细胞减灭术联合或不联合腹腔内化疗的指征。还提出了监测和全身治疗建议。
目前指导治疗的证据虽在增加，但仍主要是观察性证据，这些共识性建议为无腹膜受累的阑尾肿瘤治疗提供了专家指导。
