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The effect of proph...
The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN
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- Alexandraki, Krystallenia I. (author)
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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- Kaltsas, Gregory (author)
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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- Grozinsky-Glasberg, Simona (author)
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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- Oleinikov, Kira (author)
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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- Kos-Kudła, Beata (author)
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
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- Kogut, Angelika (author)
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
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- Srirajaskanthan, Rajaventhan (author)
- ENETS Centre of Excellence, Neuroendocrine Tumour Unit, King's College Hospital, London, UK; Department of Gastroenterology, King's College Hospital, London, UK
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- Pizanias, Michail (author)
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital, NHS FT, Institute of Liver Studies, Denmark Hill, London, UK
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- Poulia, Kalliopi-Anna (author)
- Department of Nutrition, Laiko General Hospital, Athens, Greece
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- Ferreira, Clara (author)
- Department of Nuclear Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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- Weickert, Martin O. (author)
- The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, UK; Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
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- Daskalakis, Kosmas, 1979- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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(creator_code:org_t)
- 2020-07-24
- 2020
- English.
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In: Endocrine. - : Springer. - 1355-008X .- 1559-0100. ; 70:1, s. 178-186
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Abstract
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- BACKGROUND/AIMS: Long-term outcomes are understudied in patients with well-differentiated appendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes, including health-related quality of life (HRQoL).METHODS: Eligible patients from five European referral centers were divided between those who underwent appendectomy alone and those who underwent completion pRHC. HRQoL EORTC-QLC-C30 questionnaires and cross-sectional imaging data were prospectively collected. Age- and sex-matched healthy controls were recruited for HRQoL analysis' validation.RESULTS: We included 166 patients (119 women [71.2%]: mean age at baseline: 31 ± 16 years). Mean follow-up was 50.9 ± 54 months. Most patients (152 [92%]) had tumors ≤20 mm in size. Fifty-eight patients (34.9%) underwent pRHC that in final analysis was regarded as an overtreatment in 38/58 (65.5%). In multivariable analysis, tumor size >20 mm was the only independent predictor for lymph node (LN) involvement (p = 0.002). No mortality was reported, whereas 2-, 5- and 10-year recurrence-free survival in patients subjected to postoperative cross-sectional imaging (n = 136) was 98.5%, 97.8%, and 97.8%, respectively. Global HRQoL was not significantly impaired in patients with WD-ANEN compared with age- and sex-matched healthy individuals (median scores 0.83[0.08-1] vs 0.83[0.4-1], respectively; p = 0.929). Among patients with WD-ANEN impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group.CONCLUSIONS: WD-ANEN is a low-malignant neoplasm with unconfirmed associated mortality, low recurrence rate, and overall preserved HRQoL. pRHC comes at a price of excessive surgery, functional HRQoL issues, and diarrhea. The value per se of a prophylactic surgical approach to patients with WD-ANENs <20 mm is challenged.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Appendix
- Carcinoid
- Health-related quality of life
- Neuroendocrine tumor
- Prophylactic surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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Alexandraki, Kry ...
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Kaltsas, Gregory
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Grozinsky-Glasbe ...
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Oleinikov, Kira
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Kos-Kudła, Beata
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Kogut, Angelika
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Srirajaskanthan, ...
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Pizanias, Michai ...
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Poulia, Kalliopi ...
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Ferreira, Clara
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Weickert, Martin ...
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Daskalakis, Kosm ...
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Endocrine
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Örebro University