Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

IF 1.4 Q4 ONCOLOGY Pleura and Peritoneum Pub Date : 2023-12-29 DOI:10.1515/pp-2023-0032
C. Mouawad, Armelle Bardier, Mathilde Wagner, S. Doat, D. Djelil, J. Fawaz, Marc Pocard
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Abstract

Abstract Objectives Due to the scarcity of low-grade appendiceal mucinous neoplasm (LAMN), there is an absence of systematized guidelines concerning its management, especially after incidental finding on an appendiceal specimen. In this study, we evaluate the active surveillance (AS) strategy adopted for a series of patients diagnosed with LAMN on resection specimens who were considered to have a low risk of pseudomyxoma progression. Methods Thirty patients were included between April 2014 and July 2021, with a female majority and a median follow-up period of 3.1 years. The inclusion criteria were as follows: LAMN diagnosis on appendiceal specimens, confirmed in an expert center, limited extra-appendiceal mucin resected and localized around the appendix, normal biology (CEA, CA199, CA125) and normal abdominopelvic MRI. AS included physical exam (trocar scar), biology and MRI, 6 months postoperatively, then yearly for 10 years. Results As an initial surgery, 77 % had an appendectomy as their initial intervention, 17 % had a cecectomy, and 6 % had a right colectomy. After follow-up, 87 % of patients showed no sign of disease progression by MRI, while 13 % progressed to PMP. MRI performed in the first postoperative year predicted the disease prognosis in 97 % of patients. Conclusions The AS strategy, based on MRI, is a valid option after incidental LAMN diagnosis.
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低级别阑尾粘液瘤(LAMN)的主动监测
摘要 目的 由于低级别阑尾粘液瘤(LAMN)很少见,因此缺乏有关其管理的系统化指南,尤其是在阑尾标本中偶然发现后。在本研究中,我们评估了一系列在切除标本中被诊断为 LAMN 的患者所采取的主动监测(AS)策略,这些患者被认为假性肌瘤恶化的风险较低。方法 2014 年 4 月至 2021 年 7 月间纳入了 30 例患者,其中女性占多数,中位随访时间为 3.1 年。纳入标准如下在专家中心确诊的阑尾标本上确诊为 LAMN,切除的阑尾外粘蛋白有限且位于阑尾周围,生物学指标(CEA、CA199、CA125)正常,腹盆腔 MRI 正常。AS 包括体格检查(套管疤痕)、生物学检查和核磁共振成像,术后 6 个月进行,之后 10 年每年进行一次。结果 77% 的患者在初次手术中接受了阑尾切除术,17% 的患者接受了结肠切除术,6% 的患者接受了右结肠切除术。随访后,87%的患者在核磁共振成像中未发现疾病进展迹象,13%的患者进展为PMP。术后第一年进行的磁共振成像可预测 97% 患者的疾病预后。结论 在偶然诊断出 LAMN 后,基于磁共振成像的 AS 策略是一种有效的选择。
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来源期刊
CiteScore
2.50
自引率
11.10%
发文量
23
审稿时长
9 weeks
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