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| __NOTOC__
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| {{Appendix cancer}}
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| {{CMG}}; {{AE}} {{Soroush}}
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| ==Overview==
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| 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.
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| ==Surgery==
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| *Surgery is the mainstay of treatment for appendix cancer.
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| *The feasibility as well as determining the appropriate plan of surgery depends on the stage of appendix cancer at diagnosis.
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| *'''Carcinoid tumors''' are generally treated with appendectomy, right hemicolectomy and surrounding lymph nodes dissection.
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| *'''Non-carcinoid tumors''' are candied for tumor debulking surgery; in addition to right hemicolectomy and tumor dissection (also called cytoreductive surgery), gallbladder, as well ovaries and uterus in female patients might be excised. Tumor debulking surgery might accompanied by '''[[Www.wikidoc.org/index.php/Appendix cancer medical therapy|hyperthermic intraperitoneal chemotherapy (HIPEC)]]''', specially in high stage cases with peritoneal seeding as well as in patients with pseudomyxoma peritonei.
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| *'''Approach to appendiceal carcinoid tumors'''
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| :*Tumor size plays the critical role in surgical planning for the patients with appendix carcinoid tumors.
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| :*Patients with tumors '''larger than 2 cm''' should undergo right hemicolectomy. <ref name="pmid3696178">Moertel CG, Weiland LH, Nagorney DM, Dockerty MB (1987) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3696178 Carcinoid tumor of the appendix: treatment and prognosis.] ''N Engl J Med'' 317 (27):1699-701. [http://dx.doi.org/10.1056/NEJM198712313172704 DOI:10.1056/NEJM198712313172704] PMID: [https://pubmed.gov/3696178 3696178]</ref>
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| :*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. <ref name="pmid21294132">Mullen JT, Savarese DM (2011) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21294132 Carcinoid tumors of the appendix: a population-based study.] ''J Surg Oncol'' 104 (1):41-4. [http://dx.doi.org/10.1002/jso.21888 DOI:10.1002/jso.21888] PMID: [https://pubmed.gov/21294132 21294132]</ref><ref name="pmid8466309">Roggo A, Wood WC, Ottinger LW (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8466309 Carcinoid tumors of the appendix.] ''Ann Surg'' 217 (4):385-90. PMID: [https://pubmed.gov/8466309 8466309]</ref><ref name="pmid464679">Syracuse DC, Perzin KH, Price JB, Wiedel PD, Mesa-Tejada R (1979) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=464679 Carcinoid tumors of the appendix. Mesoappendiceal extension and nodal metastases.] ''Ann Surg'' 190 (1):58-63. PMID: [https://pubmed.gov/464679 464679]</ref>
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| ::*Europian 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). <ref name="pmid22262080">Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22262080 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. [http://dx.doi.org/10.1159/000335629 DOI:10.1159/000335629] PMID: [https://pubmed.gov/22262080 22262080]</ref><ref name="pmid20664473">Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ et al. (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20664473 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. [http://dx.doi.org/10.1097/MPA.0b013e3181ebb2a5 DOI:10.1097/MPA.0b013e3181ebb2a5] PMID: [https://pubmed.gov/20664473 20664473]</ref>
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| ::*For tumors '''smaller than 1 cm''', simple appendectomy is adequate.
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| *'''Approach to mucinous adenocarcinoma of the appendix'''<ref name="pmid26648795">Kelly KJ (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=26648795 Management of Appendix Cancer.] ''Clin Colon Rectal Surg'' 28 (4):247-55. [http://dx.doi.org/10.1055/s-0035-1564433 DOI:10.1055/s-0035-1564433] PMID: [https://pubmed.gov/26648795 26648795]</ref>
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| *General expert consensus is in favor of right hemicolectomy within three months of initial appandectomy, the following aproach is recommended by Kelly et. al:
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| :*First determine weather the tumor is '''''ruptured''''' or not?<math>\blacktriangledown</math>
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| ::*If not ruptured determine the '''''grade''''' <math>\blacktriangledown</math>
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| :::*Right hemicolectomy with lymph node dissection is the appropriate approach for '''''high grade''''' tumors
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| :::*In '''''low grade''''' tumors appendectomy would be enough
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| ::*If the tumor is '''''ruptured''''' <math>\blacktriangledown</math>
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| :::* In '''''gross peritoneal disease''''' imaging to evaluate eligibility for complete cytoreduction is warranted, and if it was feasable cytoreduction and HIPEC is recommended.<ref name="pmid22302265">Low RN, Barone RM (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22302265 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. [http://dx.doi.org/10.1245/s10434-012-2236-3 DOI:10.1245/s10434-012-2236-3] PMID: [https://pubmed.gov/22302265 22302265]</ref>
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| :::* In '''''microscopic rupture''''' the '''''tumor grade''''' plays the determinant role:<math>\blacktriangledown</math>
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| ::::*laporoscopic evaluation and resection of the residual tumor is recommended for '''''low grade''''' tumors.
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| ::::* '''''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.
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category: (name of the system)]]
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