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Ann Surg. 2018 Mar 19. doi: 10.1097/SLA.0000000000002736. [Epub ahead of print]

Current Management and Predictive Factors of Lymph Node Metastasis of Appendix Neuroendocrine Tumors: A National Study from the French Group of Endocrine Tumors (GTE).

Author information

1
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France.
2
Service d'endocrinologie, Hôpital Claude Huriez, CHRU Lille, Lille, France.
3
Service d'anatomie et cytologie pathologiques, CHRU Tours, Tours, France.
4
Service d'oncologie digestive, CHU Toulouse, Toulouse, France.
5
Service d'endocrinologie, diabétologie et nutrition, CHU Angers, Angers, France.
6
Service d'anatomie et cytologie pathologiques, CHU Ambroise Paré, Boulogne Billancourt, France.
7
Service d'endocrinologie, oncologie médicale, Institut Gustave Roussy, Villejuif, France.
8
Service de Médecine Interne, Endocrinologie et Nutrition, CHU Hôpital de Hautepierre, Strasbourg, France.
9
Service de gastro-entérologie, oncologie digestive, Hôpital Cochin, Paris, France.
10
Service de l'appareil digestif, endocrinologie et nutrition, CHU Bordeaux, Bordeaux, France.
11
Service d'anatomie et cytologie pathologiques, CHU-Hôpital Gui de Chauliac, Montpellier, France.
12
Service de chirurgie, CHU Dijon, France.
13
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, Lyon, France.
14
Service d'anatomie et cytologie pathologiques, Institut Gustave Roussy, Villejuif, France.
15
University of Lyon, Université Lyon 1, France.

Abstract

OBJECTIVE:

The primary endpoint was to analyze the predictive factors of lymph node involvement (LN+).

BACKGROUND:

Indications for additional right hemicolectomy (RHC) with lymph node (LN) resection after appendectomy for appendix neuroendocrine tumor (A-NET) remain controversial, especially for tumors between 1 and 2 cm in size.

METHODS:

National study including all patients with nonmetastatic A-NET diagnosed after January, 2010 in France.

RESULTS:

In all, 403 patients were included. A-NETs were: within tip (67%), body (24%) or base (9%) of the appendix; tumor size was < 1 cm (62%), 1 to 2 cm (30%), or >2 cm (8%); grade 1 (91%); mesoappendix involvement 3 mm (5%); lymphovascular (15%) or perineural (24%) invasion; and positive resection margin (8%). According to the European NeuroEndocrine Tumor Society (ENETS) recommendations, 85 patients (21%) should have undergone RHC. The agreement between ENETS guidelines and the multidisciplinary tumor board for complementary RHC was 89%. In all, 100 (25%) patients underwent RHC with LN resection, 26 of whom had LN+. Tumor size (best cut-off at 1.95 cm), lymphovascular and perineural invasion, and pT classifications were associated with LN+. Among the 44 patients who underwent RHC for a tumor of 1 to 2 cm in size, 8 (18%) had LN+. No predictive factor of LN+ (base, resection margins, grade, mesoappendix, lymphovascular, perineural involvement) was found in this subgroup of patients.

CONCLUSIONS:

In the largest study using the latest pathological criteria for completion RHC in A-NET, a quarter of patients had residual tumor. Further studies are warranted to demonstrate the survival impact of RHC in this setting.

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