• Nicole Brighi, Stefano La Rosa, Giulio Rossi, Federica Grillo, Sara Pusceddu, Maria Rinzivillo, Francesca Spada, Salvatore Tafuto, Sara Massironi, Antongiulio Faggiano, Lorenzo Antonuzzo, Donatella Santini, Fausto Sessa, Roberta Maragliano, Fabio Gelsomino, Manuela Albertelli, Claudio Vernieri, Francesco Panzuto, Nicola Fazio, Chiara De Divitiis, Giuseppe Lamberti, Annamaria Colao, Fave Gianfranco Delle GD Digestive and Liver Disease Unit, Sant'Andrea Hospital Sapienza University of Rome, Roma, Italy., and Davide Campana.
• Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy.
• Ann. Surg. 2020 Mar 1; 271 (3): 527-533.

ObjectiveThe aim of this study was to evaluate clinical and morphological features related to nodal involvement in appendiceal neuroendocrine tumors (NETs), to identify patients who should be referred for oncological radicalization with hemicolectomy.BackgroundAppendiceal NETs are usually diagnosed accidentally after appendectomy; the indications for right hemicolectomy are currently based on several parameters (ie, tumor size, grading, proliferative index, localization, mesoappendiceal invasion, lymphovascular infiltration). Available guidelines are based on scarce evidence inferred by small, retrospective, single-institution studies, resulting in discordant recommendations.MethodsA retrospective analysis of a prospectively collected database was performed. Patients who underwent surgical resection of appendiceal NETs at 11 tertiary Italian centers, from January 1990 to December 2015, were included. Clinical and morphological data were analyzed to identify factors related to nodal involvement.ResultsFour-hundred fifty-seven patients were evaluated, and 435 were finally included and analyzed. Of them, 21 had nodal involvement. Grading G2 [odds ratio (OR) 6.04], lymphovascular infiltration (OR 10.17), size (OR 18.50), and mesoappendiceal invasion (OR 3.63) were related to nodal disease. Receiver operating characteristic curve identified >15.5 mm as the best size cutoff value (area under the curve 0.747). On multivariate analysis, grading G2 (OR 6.98), lymphovascular infiltration (OR 8.63), and size >15.5 mm (OR 35.28) were independently related to nodal involvement.ConclusionsTumor size >15.5 mm, grading G2, and presence of lymphovascular infiltration are factors independently related to nodal metastases in appendiceal NETs. Presence of ≥1 of these features should be considered an indication for oncological radicalization. Although these results represent the largest study currently available, prospective validation is needed.

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