ASO Author Reflections: Contemporary Management of Low-Grade Appendiceal Mucinous Neoplasms

Excerpt

Low-grade appendiceal mucinous neoplasms (LAMN) represent a rare appendiceal tumor with a propensity for spread within the peritoneal cavity and the potential to develop a clinical presentation of pseudomyxoma peritonei but with otherwise very low metastatic potential. Although rare, these low-grade tumors are typically initially encountered outside of tertiary or quaternary referral centers. As such, there has been significant heterogeneity in the management of these tumors. White and colleagues recently described this heterogeneity in patients presenting to the MD Anderson Cancer Center for definitive care of their LAMN.¹ Of note, a significant number of these patients received a right hemicolectomy without clear indication. Because these tumors rarely metastasize to the ileocolonic lymph nodes, both the American Society of Colon & Rectal Surgeons as well as the recent Chicago Consensus Guidelines do not recommend right hemicolectomy for oncologic staging.^2,3 Rather, partial colectomy is recommended only in the setting of direct spread from the appendix to the cecum. An ileocectomy may therefore be required to obtain a clear margin. …