Appendiceal Neuroendocrine Tumors: Does Colon Resection Improve Outcomes?

• Type of Material: Article
• Authors: Angelena Crown, Virginia Mason Medical Center; Vlad V Simianu, Virginia Mason Medical Center; Hagen Kennecke, Virginia Mason Medical Center; Alexandra G Lopez-Aguiar, Emory University; Mary Dillhoff, Ohio State University; Eliza W Beal, Ohio State University; George A Poultsides, Stanford University; Eleftherios Makris, Stanford University; Kamran Idrees, Vanderbilt University; Paula Marincola Smith, Vanderbilt University; Hari Nathan, University of Michigan; Megan Beems, University of Michigan; Daniel Abbott, University of Wisconsin; James Barrett, University of Wisconsin; Ryan C Fields, Washington University; Jesse Davidson, Washington University; Shishir Maithel, Emory University; Flavio G Rocha, Virginia Mason Medical Centerson Med Ctr
• Language: English
• Date: 2019-11-20
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Society for Surgery of the Alimentary Tract. Published by ELSEVIER INC. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11605-019-04431-6
• Title of Journal or Parent Work: JOURNAL OF GASTROINTESTINAL SURGERY
• Volume: 24
• Issue: 9
• Start Page: 2121
• End Page: 2126
• Keywords: Science & Technology; MANAGEMENT; Life Sciences & Biomedicine; ILEUM; Colectomy; CARCINOMAS; Appendiceal neuroendocrine tumor; Appendectomy; Gastroenterology & Hepatology; Surgery

Abstract

Background: Appendiceal neuroendocrine tumors (A-NETs) are rare neoplasms of the GI tract. They are typically managed according to tumor size; however, the impact of surgical strategy on the short- and long-term outcomes is unknown. Methods: All patients who underwent resection of A-NET at 8 institutions from 2000 to 2016 were analyzed retrospectively. Patient clinicopathologic features and outcomes were stratified according to resection type. Results: Of 61 patients identified with A-NET, mean age of presentation was 44.7 ± 16.0 years and patients were predominantly Caucasian (77%) and female (56%). Mean tumor size was 1.2 ± 1.3 cm with a median of 0.8 cm. Thirty-one patients (51%) underwent appendectomy and 30 (49%) underwent colonic resection. The appendectomy group had more T1 tumors (87% vs 42%, p < 0.01) than the colon resection group. Of patients in the colon resection group, 27% had positive lymph nodes and 3% had M1 disease. R0 resections were achieved in 90% of appendectomy patients and 97% of colon resection patients. Complications occurred with a higher frequency in the colon resection group (30%) compared with those in the appendectomy group (6%, p = 0.02). The colon resection group also had a longer length of stay, higher average blood loss, and longer average OR time. Median RFS and OS were similar between groups. Conclusion: A-NET RFS and OS are equivalent regardless of surgical strategy. Formal colon resection is associated with increased length of stay, OR time, higher blood loss, and more complications. Further study is warranted to identify patients that are likely to benefit from more aggressive surgery.