A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
21
09
2020
accepted:
01
12
2020
pubmed:
9
1
2021
medline:
9
7
2021
entrez:
8
1
2021
Statut:
ppublish
Résumé
Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs. The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs. We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence. We identified 217 patients with localized LAMNs. Median age was 59 years (11-95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0-271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5-47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence. This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs.
OBJECTIVE
OBJECTIVE
The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs.
METHODS
METHODS
We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence.
RESULTS
RESULTS
We identified 217 patients with localized LAMNs. Median age was 59 years (11-95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0-271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5-47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence.
CONCLUSIONS
CONCLUSIONS
This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
Identifiants
pubmed: 33415564
doi: 10.1245/s10434-020-09499-y
pii: 10.1245/s10434-020-09499-y
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
4685-4694Références
Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol. 2008;34:196–201.
doi: 10.1016/j.ejso.2007.04.002
Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27:1089–103.
doi: 10.1097/00000478-200308000-00006
World Health Organization Classification of Tumours of the Digestive Tract. 5th ed. Lyon: IARC; 2019.
Carr NJ, Cecil TD, Mohamed F, et al. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol. 2016;40:14–26.
doi: 10.1097/PAS.0000000000000535
Foster JM, Sleightholm RL, Wahlmeier S, Loggie B, Sharma P, Patel A. Early identification of DPAM in at-risk low-grade appendiceal mucinous neoplasm patients: a new approach to surveillance for peritoneal metastasis. World J Surg Oncol 2016;14:243.
doi: 10.1186/s12957-016-0996-0
Guaglio M, Sinukumar S, Kusamura S, et al. Clinical Surveillance After Macroscopically Complete Surgery for Low-Grade Appendiceal Mucinous Neoplasms (LAMN) with or without limited peritoneal spread: long-term results in a prospective series. Ann Surg Oncol. 2018;25:878–84.
doi: 10.1245/s10434-017-6305-5
McDonald JR, O’Dwyer ST, Rout S, et al. Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms. Br J Surg. 2012;99:987–92.
doi: 10.1002/bjs.8739
Pai RK, Beck AH, Norton JA, Longacre TA. Appendiceal mucinous neoplasms: clinicopathologic study of 116 cases with analysis of factors predicting recurrence. Am J Surg Pathol. 2009;33:1425–39.
doi: 10.1097/PAS.0b013e3181af6067
Tiselius C, Kindler C, Shetye J, Letocha H, Smedh K. computed tomography follow-up assessment of patients with low-grade appendiceal mucinous neoplasms: evaluation of risk for pseudomyxoma peritonei. Ann Surg Oncol. 2017;24:1778–82.
doi: 10.1245/s10434-016-5623-3
Wong M, Barrows B, Gangi A, Kim S, Mertens RB, Dhall D. Low-grade appendiceal mucinous neoplasms: a single institution experience of 64 cases with clinical follow-up and correlation with the current (eighth edition) AJCC staging. Int J Surg Pathol. 2020;28(3):252–8.
doi: 10.1177/1066896919883679
Yantiss RK, Shia J, Klimstra DS, Hahn HP, Odze RD, Misdraji J. Prognostic significance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol. 2009;33:248–55.
doi: 10.1097/PAS.0b013e31817ec31e
Mittal R, Chandramohan A, Moran B. Pseudomyxoma peritonei: natural history and treatment. Int J Hyperthermia. 2017;33:511–9.
doi: 10.1080/02656736.2017.1310938
González-Moreno S, Sugarbaker PH. Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding. Br J Surg. 2004;91:304–11.
doi: 10.1002/bjs.4393
Fournier K, Rafeeq S, Taggart M, et al. Low-grade appendiceal mucinous neoplasm of uncertain malignant potential (LAMN-UMP): prognostic factors and implications for treatment and follow-up. Ann Surg Oncol. 2017;24:187–93.
doi: 10.1245/s10434-016-5588-2
Honore C, Caruso F, Dartigues P, et al. Strategies for preventing pseudomyxoma peritonei after resection of a mucinous neoplasm of the appendix. Anticancer Res. 2015;35:4943–7.
pubmed: 26254392
Li X, Zhou J, Dong M, Yang L. Management and prognosis of low-grade appendiceal mucinous neoplasms: a clinicopathologic analysis of 50 cases. Eur J Surg Oncol. 2018;44:1640–5.
doi: 10.1016/j.ejso.2018.06.037
Arnason T, Kamionek M, Yang M, Yantiss RK, Misdraji J. Significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms. Arch Pathol Lab Med. 2015;139:518–21.
doi: 10.5858/arpa.2014-0246-OA
Solomon D, Bekhor E, Leigh N, et al. Surveillance of low-grade appendiceal mucinous neoplasms with peritoneal metastases after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: are 5 years enough? A multisite experience. Ann Surg Oncol. 2020;27:147–53.
doi: 10.1245/s10434-019-07678-0