Lymph Node Positivity in Appendiceal Adenocarcinoma: Should Size Matter?

Gahagan, John V.; Whealon, Matthew D.; Phelan, Michael; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J.; Nguyen, Ninh T.; Carmichael, Joseph C.

doi:10.1016/j.jamcollsurg.2017.01.056

Cited by 19 publications

(14 citation statements)

References 14 publications

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“…A recent National Cancer Database study found that 19% of AAs larger than 1 cm had lymph node involvement; the rate was 28% for AAs that were 1 to 2 cm. 66 Rates of lymph node involvement were 0%, 11%, and 12% for tumors that were in situ, T1, and T2, respectively. These numbers were quite similar to those for primary colon adenocarcinomas.…”

Section: Managementmentioning

confidence: 92%

Current Management of Appendiceal Neoplasms

Hoehn

Rieser

Choudry

et al. 2021

American Society of Clinical Oncology Educational Book

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Appendiceal neoplasms include a heterogeneous group of epithelial and nonepithelial tumors that exhibit varying malignant potential. This review article summarizes current diagnostic criteria, classification systems, and optimal therapeutic strategies for the five main histopathologic subtypes of appendiceal neoplasms. In particular, the management of epithelial appendiceal neoplasms has evolved. Although their treatment has historically been extrapolated from colon cancer, improved understanding of their unique histopathologic and molecular characteristics and a growing body of published clinical data support a more nuanced approach to their management.

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Section: Managementmentioning

confidence: 92%

Current Management of Appendiceal Neoplasms

Hoehn

Rieser

Choudry

et al. 2021

American Society of Clinical Oncology Educational Book

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“…Our data show that the lymph node metastasis in right colon cancer patients first appear in the bowel axis lymph nodes, and then to the central lymph nodes. Colon tumor cells tend to metastasize to lymph nodes close to the axis of the bowel [ 28 , 29 ]. In addition, the total metastasis rate of right colon cancer in T1, T2, T3, and T4 were 11.1%, 14.3%, 42.2%, and 69.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

Liu

et al. 2021

World J Surg Onc

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Background D3 or complete mesocolic excision (CME) surgery has become a common surgical procedure for the treatment of colon cancer metastasis. Clinical misuse and overuse of lymph node dissection bring unnecessary burdens to patients. A detailed guidance for lymph node dissection in patients with T3 and T4 stage right colon cancer at different locations is urgently needed. Methods A retrospective study was performed. Patients received D3 or CME surgery were divided into ileocecal group, ascending colon group, and hepatic flexure group according to the 9th edition of the Japanese Society for Cancer of the Colon and Rectum guidelines. The distributions of lymph node metastases were analyzed according to tumor infiltration depth (T stage) and tumor location. Results The incidence of metastases in the paracolic area (or station), intermediate area, and main (or central) area was 38.4% (139/362), 12.7% (46/362), and 9.7% (35/362), respectively. The proportion of patients having No.206 and terminal ileum lymph nodes metastases was 7.7% (14/181) and 3.7% (9/244), respectively. No.206 lymph node metastasis is related to tumor location (χ2 = 7.955, p = 0.019) and degree of differentiation (χ2 = 18.99, p = 0.000), and terminal ileum lymph node metastasis is related to tumor location (χ2 = 6.273, p = 0.043). Patients with T3/T4 hepatic flexure cancer received radical right hemicolectomy in addition to No.206 lymph node dissection. Conclusion Radical right hemicolectomy and No.206 group lymph node dissection are necessary for T3 and T4 stage colon cancer therapy.

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“…Moreover, the number of lymph nodes examined was not associated with LN+ in this study ( P = .207). Based on the information provided in the NCDB for appendiceal adenocarcinomas, it seems that the nationwide management of MAC varies and may not be representative of recommendations for lymph node harvest or formal hemicolectomy 12,13 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, LN+ appears to confer a worse prognosis even in the setting of peritoneal disease in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) 9‐11 . Because of the relatively high frequency of regional LN+ in patients with any appendiceal adenocarcinoma and the prognostic value of LN+ in this population, the general consensus is to perform a right colectomy, irrespective of the characteristics of the appendiceal cancer, particularly in the presence of high‐grade disease 12,13 . Even so, if providers deem there is a low probability of LN+ in a patient with MAC, they may opt to not offer a hemicolectomy.…”

Section: Introductionmentioning

confidence: 99%

Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma

Shannon

Goldberg

Song

et al. 2020

Journal of Surgical Oncology

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Background Lymph node metastasis (LN+) is a prognostic factor in appendiceal cancers, but predictors and outcomes for LN+ in mucinous appendiceal adenocarcinoma (MAC) remain poorly defined. Methods Patients were identified from the 2010 to 2016 NCDB who underwent surgical resection as first‐line management for Stage I‐III mucinous appendiceal cancer. A LN+ risk‐score model was developed using multivariable regression on a training data set and internally validated using a testing data set. Three‐year overall survival (OS) was analyzed by Cox proportional hazards regression. Results Of 1158 patients, LN+ (N = 244, 21.1%) patients were more likely to have higher pT group and grade of disease, lymphovascular invasion (LVI), and positive margins on univariate analyses. Predictive factors associated with LN+ on multivariable analysis included positive surgical margins (odds ratio [OR] 3.00, P <.0001), higher grade (moderately differentiated: OR, 2.16, P < .0001; poorly or undifferentiated: OR, 3.07, P < .0001), and LVI (OR, 7.28, P < .0001). A validated risk‐score model using these factors was developed with good performance (AUC 0.749). LN+ patients had a worse 3‐year OS compared with LN− patients (17.4% vs 82.6%, hazard ratio 1.96, P = .001). Conclusions LN+ is associated with worse survival in patients with MAC. A risk‐score model using margin status, LVI, and grade can accurately risk stratify patients for LN+.

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Lymph Node Positivity in Appendiceal Adenocarcinoma: Should Size Matter?

Cited by 19 publications

References 14 publications

Current Management of Appendiceal Neoplasms

Current Management of Appendiceal Neoplasms

Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma

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