Appendix cancer surgery

Jump to navigation Jump to search

Appendix cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Differentiating Appendix cancer from other Diseases

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

MRI

CT scan

Echocardiography and Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Appendix cancer surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Appendix cancer surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Appendix cancer surgery

CDC on Appendix cancer surgery

Appendix cancer surgery in the news

Blogs on Appendix cancer surgery

Directions to Hospitals Treating Appendix cancer

Risk calculators and risk factors for Appendix cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Surgery is the mainstay of treatment for appendix cancer. The feasibility as well as determining the appropriate plan of surgery depends on the stage of appendix cancer at diagnosis. Tumor size plays the crucial role in determining the need for further surgery.

Indications

Surgery

  • Tumor size plays the critical role in surgical planning for the patients with appendix carcinoid tumor.[2]
  • Patients with tumors larger than 2 cm should undergo right hemicolectomy.[2]
  • It has been controversial weather patients with smaller tumors benefit from right hemicolectomy or not? Although the Mayo Clinic study on 120 patients suggested appendectomy as the sufficient intervention in tumors smaller than 2 cm, but recent studies raised some concerns in this regard; indeed a higher potential for metastatic disease and lymph node metastasis has been demonstrated in new reports as well as SEER database, specially in mesoappendical invasion.[3][4][5]
  • European Neuroendocrine Tumor Society (ENETS) and North American Neuroendocrine Tumor Society (NANETS) consensus based guideline suggests right hemicolectomy for tumors between 1 and 2 cm in the presence of deep mesoappendiceal invasion, positive or uncertain margins, high proliferation rate, angioinvasion and mixed histology (adenocarcionid, goblet cell cacionid).[6][7]
  • For tumors smaller than 1 cm, simple appendectomy is adequate.
  • Approach to mucinous adenocarcinoma of the appendix[1]
  • General expert consensus is in favor of right hemicolectomy within three months of initial appandectomy, the following aproach is recommended by Kelly et. al:
  • First determine weather the tumor is ruptured or not?
  • If not ruptured determine the grade
  • Right hemicolectomy with lymph node dissection is the appropriate approach for high grade tumors
  • In low grade tumors appendectomy would be enough
  • If the tumor is ruptured
  • In gross peritoneal disease imaging to evaluate eligibility for complete cytoreduction is warranted, and if it was feasable cytoreduction and HIPEC is recommended.[8]
  • In microscopic rupture the tumor grade plays the determinant role:
  • laporoscopic evaluation and resection of the residual tumor is recommended for low grade tumors.
  • High grade tumors should be treated with laparotomy, residual tumor removal, right hemicolectomy, omentectomy, right lower quadrant peritonectomy, plus bilateral oophorectomy in female patients, followed by HIPEC.

References

  1. 1.0 1.1 1.2 Kelly KJ (2015) Management of Appendix Cancer. Clin Colon Rectal Surg 28 (4):247-55. DOI:10.1055/s-0035-1564433 PMID: 26648795
  2. 2.0 2.1 2.2 Moertel CG, Weiland LH, Nagorney DM, Dockerty MB (1987) Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med 317 (27):1699-701. DOI:10.1056/NEJM198712313172704 PMID: 3696178
  3. Mullen JT, Savarese DM (2011) Carcinoid tumors of the appendix: a population-based study. J Surg Oncol 104 (1):41-4. DOI:10.1002/jso.21888 PMID: 21294132
  4. Roggo A, Wood WC, Ottinger LW (1993) Carcinoid tumors of the appendix. Ann Surg 217 (4):385-90. PMID: 8466309
  5. Syracuse DC, Perzin KH, Price JB, Wiedel PD, Mesa-Tejada R (1979) Carcinoid tumors of the appendix. Mesoappendiceal extension and nodal metastases. Ann Surg 190 (1):58-63. PMID: 464679
  6. Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F et al. (2012) ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 95 (2):135-56. DOI:10.1159/000335629 PMID: 22262080
  7. Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ et al. (2010) The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas 39 (6):753-66. DOI:10.1097/MPA.0b013e3181ebb2a5 PMID: 20664473
  8. Low RN, Barone RM (2012) Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 19 (5):1394-1401. DOI:10.1245/s10434-012-2236-3 PMID: 22302265
  9. 9.0 9.1 Stocchi L, Wolff BG, Larson DR, Harrington JR (2003) Surgical treatment of appendiceal mucocele. Arch Surg 138 (6):585-9; discussion 589-90. DOI:10.1001/archsurg.138.6.585 PMID: 12799327
  10. 10.0 10.1 10.2 Lo NS, Sarr MG (2003) Mucinous cystadenocarcinoma of the appendix. The controversy persists: a review. Hepatogastroenterology 50 (50):432-7. PMID: 12749241

Template:WH Template:WS