Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms

McDonald, James R.; O’Dwyer, Sarah T; Rout, Shantanu; Chakrabarty, Bipasha; Sikand, Kanwal A; Fulford, Paul E; Wilson, Malcolm S; Renehan, Andrew G

doi:10.1002/bjs.8739

Cited by 93 publications

(77 citation statements)

References 19 publications

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“…16,22,35 Cytoreductive surgery and perioperative intraperitoneal chemotherapy are now considered a standard of care for PMP, 36 and prognostic assessments from histopathology performed at institutions not using this technique must be approached with caution. Nevertheless, pathologic appearances have been consistently demonstrated to be a key independent prognostic factor in PMP 5,13,16,20,35,37 and a uniform classification with prognostic significance is a crucial tool in clinical evaluation and therapeutic decision-making. The collective experience of the panel is that the clinical features of PMP can be produced by a range of histopathologic entities and we believe consistent reporting practices will facilitate the gathering of good data to help determine which lesions are amenable to cytoreductive surgery.…”

Section: Discussionmentioning

confidence: 99%

A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia

Carr

Cecil

Mohamed

et al. 2016

American Journal of Surgical Pathology

615

463

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Pseudomyxoma peritonei (PMP) is a complex disease with unique biological behavior that usually arises from appendiceal mucinous neoplasia. The classification of PMP and its primary appendiceal neoplasia is contentious, and an international modified Delphi consensus process was instigated to address terminology and definitions. A classification of mucinous appendiceal neoplasia was developed, and it was agreed that "mucinous adenocarcinoma" should be reserved for lesions with infiltrative invasion. The term "low-grade appendiceal mucinous neoplasm" was supported and it was agreed that "cystadenoma" should no longer be recommended. A new term of "high-grade appendiceal mucinous neoplasm" was proposed for lesions without infiltrative invasion but with high-grade cytologic atypia. Serrated polyp with or without dysplasia was preferred for tumors with serrated features confined to the mucosa with an intact muscularis mucosae. Consensus was achieved on the pathologic classification of PMP, defined as the intraperitoneal accumulation of mucus due to mucinous neoplasia characterized by the redistribution phenomenon. Three categories of PMP were agreed-low grade, high grade, and high grade with signet ring cells. Acellular mucin should be classified separately. It was agreed that low-grade and high-grade mucinous carcinoma peritonei should be considered synonymous with disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis, respectively. A checklist for the pathologic reporting of PMP and appendiceal mucinous neoplasms was also developed. By adopting the classifications and definitions that were agreed, different centers will be able to use uniform terminology that will allow meaningful comparison of their results.

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Section: Discussionmentioning

confidence: 99%

A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia

Carr

Cecil

Mohamed

et al. 2016

American Journal of Surgical Pathology

615

463

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“…Same results were shown by Gonzalez-Moreno and Sugarbaker [18] who reviewed 501 patients diagnosed with appendiceal epi thelial neoplasm. Now most authors agree that complete cytoreduction with HIPEC rather than debulking surgery is the gold standard for PMP treatment [13,17,[19][20][21]. The main goal of PMP treatment is the prevention of locoregional recurrence rather than systemic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, AMCa spread through the wall of the appendix into the intraperitoneal cavity and rarely metastasize to the lymph nodes [15,16]. On this account, a less aggressive surgical approach than right colectomy has been suggested; thus, tumours confined to the appendix without evidence of peritoneal dissemination or PMP (adenoma or low-grade AMCa) are resected [3,4,10,17]. We disagree with sending frozen sections for histology -the report is often very inaccurate, lacking information on the progression of the disease, and the specimen is spoilt for better elective examination.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Surgery for Appendiceal Mucinous Tumours

Dulskas

Poškus

et al. 2017

Visc Med

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Background: Appendiceal mucinous tumour (AMT) is a very uncommon disease. We aimed to evaluate preoperative and postoperative characteristics as well as long-term outcomes of patients with appendiceal mucinous adenomas and peritoneal pseudomyxoma (PMP). Methods: A consecutive cohort of patients diagnosed with AMT were included in the study. Tumour recurrence and the development of PMP was diagnosed based on the patients' complaints, physical examination, imaging studies, and biopsy results. The calculation of survival rates was performed using the Kaplan-Meier method. Results: Between January 2003 and February 2013, 25 patients had AMT. 15 patients underwent appendectomy only (60%), 5 patients (20%) right hemicolectomy, 4 patients (16%) cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC), and 1 patient (4%) appendectomy with caecal resection. Another 2 patients underwent CRS and HIPEC 4 days and 3 years, respectively, following initial appendectomy. In the histopathologic examination, adenoma was diagnosed in 12 patients (48%); among these, low-grade PMP was found in 1 patient (4%). Low-grade appendiceal mucinous adenocarcinoma (AMCa) was diagnosed in 11 patients (44%); among these, low-grade PMP was found in seven cases (28%) and high-grade AMCa was diagnosed in 2 patients (8%). 2 of 8 PMP patients did not undergo CRS ± HIPEC because of comorbidities. The 5-year overall survival was 100% for the adenomas and 62% for PMP patients. Conclusion: AMT is a very rare entity with a considerably good outcome even in disseminated disease. CRS and HIPEC is a gold standard treatment for PMP with excellent prognosis. However, our results could still be improved in the future.

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“…In fact, in these cases, it is generally recommended to combine HIPEC and surgery. An increasing aggressiveness in operative procedures is required, shifting from a LAMN-II tumor with negative lymph nodes, resection margins, and cytology that requires appendectomy + HIPEC, to a perforated tumor with positive cytology, resection margins, and lymph nodes, which requires right colectomy associated with a peritonectomy procedure and HIPEC [76,[78][79][80].…”

Section: Treating Appendiceal Mucocelesmentioning

confidence: 99%

Pseudomyxoma Peritonei

Vaira¹,

Robella²,

Mellano³

et al. 2015

Treatment of Peritoneal Surface Malignancies

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Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms

Abstract: This study identified two LAMN subtypes. Type II lesions have pathological features of increased risk for dissemination and should be considered for risk-reducing cytoreductive surgery.

Cited by 93 publications

References 19 publications

A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia

A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia

Long-Term Outcomes after Surgery for Appendiceal Mucinous Tumours

Pseudomyxoma Peritonei

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