Postoperative surveillance of small appendiceal carcinoid tumors

Abstract

Summary Sentences Patients with appendiceal carcinoid tumors ≤1 cm diagnosed over a 16-year period in a single institution were retrospectively analyzed for disease-specific survival and recurrence. Although there was variation in post-operative surveillance strategies and frequency, there were no cases of tumor recurrence or disease-specific mortality in the follow-up period. Consistent with prior studies, we conclude that post-resection surveillance may not be necessary for tumors ≤1 cm after an R0 resection.

ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas)

“…but with risk factors (i.e. localization at the base of the appendix, mesoappendiceal invasion >3 mm, G2 NET or vascular invasion), regular follow-up seems advisable due to the presumed risk of lymph node metastasis but any benefit for the prevention of tumor recurrence or an influence on long-term outcome is unproven [65]. It should be considered that neither the determination of surrogate parameters (i.e.…”

“…For cases with right-sided hemicolectomy due to a size >1 cm but without proof of lymph node involvement or any other residual disease in the resected specimen, again no specific follow-up strategy seems to be necessary [65]. For cases with involvement of the lymph nodes or any cases with resected distant metastases, however, long-term follow-up is advised because of the proven invasiveness of the tumor.…”

Appendiceal neuroendocrine neoplasms: diagnosis and management

“…There are a few cases in which RHC was the initial surgical intervention when the neoplasm was grossly evident and the diagnosis was made preoperatively (Deeg et al 2003, Gilboa et al 2008, Coursey et al 2010, Murray et al 2014.…”

“…The great majority of aNENs (95%) are !2 cm in diameter: 60-85% are !1 cm and 4-27% are 1-2 cm, whereas only 2-17% are O2 cm (Moertel et al 1987, Roggo et al 1993. The risk of metastases in tumours !1 cm in diameter has been traditionally considered to be virtually zero (Stinner et al 1996, Murray et al 2014. In one small retrospective study of patients with tumours !1 cm in which a simple appendicectomy was performed, no patient was found to have evidence of residual disease or recurrence after a median follow-up period of 5 years (range: 6 months-15 years) (Murray et al 2014).…”

“…The risk of metastases in tumours !1 cm in diameter has been traditionally considered to be virtually zero (Stinner et al 1996, Murray et al 2014. In one small retrospective study of patients with tumours !1 cm in which a simple appendicectomy was performed, no patient was found to have evidence of residual disease or recurrence after a median follow-up period of 5 years (range: 6 months-15 years) (Murray et al 2014). Several studies report metastatic rates as low as 0-1% in tumours measuring 1-2 cm as opposed to tumours O2 cm, which may develop mostly regional metastases in 20-85% (Stinner et al 1996, Stinner & Rothmund 2005, Mullen & Savarese 2011.…”