Abstract
BackgroundAppendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. MethodRetrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. ConclusionAMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence.
Highlights
Mucinous tumors may originate from several sites including appen dix, ovary, colon, pancreas and gallbladder [1]
Despite that appendi ceal tumors are rare, appendiceal mucinous neoplasms (AMNs) are the second most common tumors that affect the appendix after carcinoid tumors [2]
The current retrospective chart review is of all pa tients at HMC with suspected clinical and/or radiological appendicular pathology who underwent elective or emergent surgery with intention to treat between January 2011 to December 2018 with a follow up to December 2020
Summary
Mucinous tumors may originate from several sites including appen dix, ovary, colon, pancreas and gallbladder [1]. Despite that appendi ceal tumors are rare (about 1% of all appendectomies), appendiceal mucinous neoplasms (AMNs) are the second most common tumors that affect the appendix after carcinoid tumors [2]. AM has widely variable behavior, ranging from non-neoplastic to neoplastic [3] Such uncertain malignant potential and the possibility of recurrence has led to many histologic classifications. Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Prognostic categories were significantly inversely correlated with recurrence risk; useful in predicting prognosis. AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence
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