Canbak Tolga, Erdem Olgun, Acar Aylin, Başak Fatih
Department of General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Umraniye/Istanbul, 34760, Turkey.
Bingol State Hospital, Clinic of General Surgery, Bingol, Turkey.
BMC Surg. 2025 Jul 28;25(1):320. doi: 10.1186/s12893-025-03037-x.
Appendiceal neuroendocrine neoplasms (ANENs) are often incidental findings following appendectomy. The necessity of complementary right hemicolectomy (RHC) for ANENs with high-risk features (HRFs), such as tumor size over 2 cm, mesoappendiceal invasion, Ki-67 index > 10%, or positive lymphovascular invasion, remains debated. This study investigates the association between HRFs and disease-free survival (DFS) to assess the need for routine RHC in ANEN patients with HRFs.
We retrospectively reviewed records of patients who underwent appendectomy between 2008 and 2018 and had ANENs on histopathology. High-risk features were defined based on tumor size, Ki-67 index, surgical margin status, and lymphovascular invasion. Patients with insufficient follow-up were contacted for additional imaging. Kaplan-Meier survival analysis was employed to assess DFS across different risk groups. DFS was defined as the interval between appendectomy and relapse, measured in months. Data were analyzed using descriptive statistics, and categorical variables were summarized as frequencies.
Thirty-four ANEN patients were identified, with 12 having no HRFs and 22 exhibiting at least one. Only three patients underwent RHC, none of whom demonstrated residual or metastatic disease on follow-up. The mean follow-up was 117.2 months, during which all patients, except one who died in an accident, remained alive and disease-free. Kaplan-Meier survival analysis showed no significant difference in DFS between patients with and without HRFs.
Routine RHC may not improve outcomes for ANENs with HRFs, as DFS remained high without additional intervention. However, given the small sample size, a multi-center study with a larger cohort is necessary to confirm these findings.
阑尾神经内分泌肿瘤（ANENs）常在阑尾切除术后偶然发现。对于具有高风险特征（HRFs）的ANENs，如肿瘤大小超过2 cm、阑尾系膜侵犯、Ki-67指数>10%或淋巴管侵犯阳性，是否需要进行补充性右半结肠切除术（RHC）仍存在争议。本研究调查HRFs与无病生存期（DFS）之间的关联，以评估具有HRFs的ANEN患者常规RHC的必要性。
我们回顾性分析了2008年至2018年间接受阑尾切除术且组织病理学检查发现ANENs的患者记录。根据肿瘤大小、Ki-67指数、手术切缘状态和淋巴管侵犯来定义高风险特征。对随访不足的患者进行额外影像学检查。采用Kaplan-Meier生存分析评估不同风险组的DFS。DFS定义为阑尾切除术后至复发的间隔时间，以月为单位。数据采用描述性统计分析，分类变量以频率进行汇总。
共确定34例ANEN患者，其中12例无HRFs，22例至少有一项HRFs。仅3例患者接受了RHC，随访时均未发现残留或转移性疾病。平均随访时间为117.2个月，在此期间，除1例死于意外外，所有患者均存活且无病。Kaplan-Meier生存分析显示，有HRFs和无HRFs的患者DFS无显著差异。
对于具有HRFs的ANENs，常规RHC可能无法改善预后，因为在无额外干预的情况下DFS仍然较高。然而，鉴于样本量较小，需要进行一项更大队列的多中心研究来证实这些发现。
