Pathologic Factors Associated with Low Risk of Lymph Node Metastasis in Nonmucinous Adenocarcinoma of the Appendix

Straker, Richard J.; Grinberg, Samuel; Sharon, Cimarron E.; Shannon, Adrienne B.; Fraker, Douglas L.; Shanmugan, Skandan; Miura, John T.; Karakousis, Giorgos C.

doi:10.1245/s10434-021-11213-5

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…The findings from Straker et al 3 are not completely surprising. For selected early-stage colon and rectal cancer with disease confined to the mucosa, favorable pathologic characteristics, and a low risk of nodal metastases, local resection is a reasonable treatment option.…”

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confidence: 87%

“…We applaud Straker et al 3 for conducting a thorough investigation into identification of low-risk patients with NMACA who can forego a more extensive operation. With the challenges of performing randomized clinical trials for such a rare patient population, data from projects such as this can provide clarity in patient care.…”

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confidence: 99%

“…The data show that less extensive resections are being performed in clinical practice. Straker et al 3 not only emphasized the group with a low risk of having nodal metastases; they also identified which patients have almost a 30 % risk of positive lymph nodes (T2 or greater, poorly differentiated, and those with lymphovascular invasion) and therefore should undergo an RHC.…”

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confidence: 99%

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Low-Risk Non-mucinous Adenocarcinoma of the Appendix: When Is an Appendectomy Enough?

Turner

Patel

2022

Ann Surg Oncol

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Non-metastatic adenocarcinoma of the appendix, often found incidentally after routine appendectomy, is a rare cancer whose subsequent management still is debated. It is classified into two general categories: mucinous and nonmucinous adenocarcinoma of the appendix (NMACA). The behavior of NMACA, considered similar to that of colon adenocarcinoma, exhibits more aggressive growth and has high rates of lymph node (LN) metastasis. 1 The management of NMACA involves performing a formal right hemicolectomy (RHC), not only to obtain a margin negative resection, but also to achieve optimal lymph node sampling for appropriate staging. 1 However, not all NMACAs are created equal. 2 In this timely study, Straker et al. 3 used the National Cancer Database (NCDB) to identify a low-risk group of NMACAs for which less extensive surgical resection (i.e., appendectomy/partial colectomy [A/PC]) would be appropriate. They found that patients who had T1 tumors with good to moderate differentiation and no lymphovascular invasion (LVI) had a low risk of LN metastasis (1.8 %). In contrast, positive LNs were found in roughly one fourth of all other patients. Examination of the entire patient cohort showed that RHC was associated with better overall survival (OS) than an A/PC. However, in the small group with DISCLOSURE There are no conflicts of interest.

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confidence: 87%

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confidence: 99%

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confidence: 99%

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Low-Risk Non-mucinous Adenocarcinoma of the Appendix: When Is an Appendectomy Enough?

Turner

Patel

2022

Ann Surg Oncol

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“…147 Although stage migration and limitations of current research may contribute to the observed benefit of RHC, it has been associated with survival benefit in most mucinous adenocarcinomas with a stage greater than 1, and any non-mucinous adenocarcinoma. 148,149 The exception to this is well-differentiated mucinous adenocarcinoma that is completely confined to the appendix with negative margins and no concern for more distant disease. The rate of lymph node positivity has been shown to be low in well-and some moderately-differentiated mucinous lesions, decreasing the survival benefit of RHC.…”

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confidence: 99%

Section: Appendiceal Adenocarcinomamentioning

confidence: 99%

Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Turaga

2024

Preprint

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Background: Appendiceal tumors comprise a heterogeneous group of tumors which may be localized or disseminate throughout the peritoneum. Limited high quality clinical data exists and many practices have been extrapolated from colorectal cancer without validation in appendiceal cohorts. Many controversies exist regarding their treatment, 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. Methods The 2018 Chicago consensus guideline was updated via 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. Results Most supporting literature consists of observational studies, but increasingly high-quality studies 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. Over 90% consensus was achieved for all pathway blocks. Key points include minimizing intervention invasiveness where permitted by pathologic classification and margin status, and determining what margin and pathologic findings are indications for consideration of cytoreduction with or without intraperitoneal chemotherapy. Surveillance and systemic therapy recommendations are also presented. Conclusion 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.

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Appendix Neoplasms

Sutton,

O’Dwyer

2024

Coloproctology

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Pathologic Factors Associated with Low Risk of Lymph Node Metastasis in Nonmucinous Adenocarcinoma of the Appendix

Cited by 10 publications

References 17 publications

Low-Risk Non-mucinous Adenocarcinoma of the Appendix: When Is an Appendectomy Enough?

Low-Risk Non-mucinous Adenocarcinoma of the Appendix: When Is an Appendectomy Enough?

Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Appendix Neoplasms

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