TY - JOUR
T1 - Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1–2 cm in size
T2 - a retrospective, Europe-wide, pooled cohort study
AU - Nesti, C. dric
AU - Bräutigam, Konstantin
AU - Benavent, Marta
AU - Bernal, Laura
AU - Boharoon, Hessa
AU - Botling, Johan
AU - Bouroumeau, Antonin
AU - Brcic, Iva
AU - Brunner, Maximilian
AU - Cadiot, Guillaume
AU - Camara, Maria
AU - Christ, Emanuel
AU - Clerici, Thomas
AU - Clift, Ashley K.
AU - Clouston, Hamish
AU - Cobianchi, Lorenzo
AU - Ćwikła, Jarosław B.
AU - Daskalakis, Kosmas
AU - Frilling, Andrea
AU - Garcia-Carbonero, Rocio
AU - Grozinsky-Glasberg, Simona
AU - Hernando, Jorge
AU - Hervieu, Valérie
AU - Hofland, Johannes
AU - Holmager, Pernille
AU - Inzani, Frediano
AU - Jann, Henning
AU - Jimenez-Fonseca, Paula
AU - Kaçmaz, Enes
AU - Kaemmerer, Daniel
AU - Kaltsas, Gregory
AU - Klimacek, Branislav
AU - Knigge, Ulrich
AU - Kolasińska-Ćwikła, Agnieszka
AU - Kolb, Walter
AU - Kos-Kudła, Beata
AU - Kunze, Catarina Alisa
AU - Landolfi, Stefania
AU - Rosa, Stefano La
AU - López, Carlos L. pez
AU - Lorenz, Kerstin
AU - Matter, Maurice
AU - Mazal, Peter
AU - Mestre-Alagarda, Claudia
AU - del Burgo, Patricia Morales
AU - van Dijkum, Els J. M. Nieveen
AU - Oleinikov, Kira
AU - Orci, Lorenzo A.
AU - Panzuto, Francesco
AU - Pavel, Marianne
AU - Perrier, Marine
AU - Reims, Henrik Mikael
AU - Rindi, Guido
AU - Rinke, Anja
AU - Rinzivillo, Maria
AU - Sagaert, Xavier
AU - Satiroglu, Ilker
AU - Selberherr, Andreas
AU - Siebenhüner, Alexander R.
AU - Tesselaar, Margot E. T.
AU - Thalhammer, Michael J.
AU - Thiis-Evensen, Espen
AU - Toumpanakis, Christos
AU - Vandamme, Timon
AU - van den Berg, José G.
AU - Vanoli, Alessandro
AU - van Velthuysen, Marie-Louise F.
AU - Verslype, Chris
AU - Vorburger, Stephan A.
AU - Lugli, Alessandro
AU - Ramage, John
AU - Zwahlen, Marcel
AU - Perren, Aurel
AU - Kaderli, Reto M.
N1 - Funding Information: This study was funded by the Swiss Cancer Research foundation (KFS-4741-02-2019) (KFS-4741-02-2019). We are grateful to Kristien Dumon, Angelika Kogut, and Giuseppe Quero, for their help in data compilation. Furthermore, we thank Karine Atlan and Fiona Rodepeter for revising pathological samples of patients. Additionally, we thank Shira Baram and Steven Brown for their support in the process to prepare our study in the UK. Publisher Copyright: © 2023 Elsevier Ltd
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Awareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1–2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1–2 cm in size in patients with or without right-sided hemicolectomy. Methods: In this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1–2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693. Findings: 282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1–2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0–15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 –21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36–2·17]; p=0·71). Interpretation: This study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1–2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort. Funding: Swiss Cancer Research foundation.
AB - Background: Awareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1–2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1–2 cm in size in patients with or without right-sided hemicolectomy. Methods: In this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1–2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693. Findings: 282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1–2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0–15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 –21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36–2·17]; p=0·71). Interpretation: This study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1–2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort. Funding: Swiss Cancer Research foundation.
UR - http://www.scopus.com/inward/record.url?scp=85147216678&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S1470-2045(22)00750-1
DO - https://doi.org/10.1016/S1470-2045(22)00750-1
M3 - Article
C2 - 36640790
SN - 1470-2045
VL - 24
SP - 187
EP - 194
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 2
ER -