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Histopathological diagnosis of appendiceal neuroendocrine neoplasms: when to perform a right hemicolectomy? A systematic review and meta-analysis

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Abstract

Purpose

The European Neuroendocrine Tumor Society (ENETS) guidelines advocate a right hemicolectomy (RHC) only in patients with appendiceal neuroendocrine neoplasms (aNENs) at risk for N+(node positive). The risk is defined using site, size, and grading of tumor as well as mesoappendiceal or lymphovascular invasion.

Methods

A systematic review and meta-analysis was carried out. The data were reported using risk difference (RD) to define the risk of N+. The number needed to treat/harm (NNT/NNH) and the likelihood of being helped or harmed (LHH) were calculated using RD. Two strategies were considered: “to treat all” versus “to treat only patients having aNENs with risk stigmata”. The aim was to evaluate the harm/benefit ratio related to the use of the ENETS lymph-nodal metastases (N+) risk factors.

Results

Six studies were included involving a total of 261 patients. The RD (−0.30; P < 0.001) of N+ was significantly lower in aNENs ≤ 20 mm as compared to those >20 mm. One unnecessary RHC every five patients (NNT = 5) could be avoided while 1 patient with N+ every six patients (NNH = 6) remained untreated. The risk was lower than the benefits (LHH = 1.2). The RD NNT, NNH, and LHH values suggested that only a 15 mm cutoff and the presence of lymphovascular invasion could be considered useful.

Conclusions

An RHC should be performed in patients with aNENs >20 mm. The use of a 15 mm cutoff criterion had a similar outcome to that of a 20 mm cutoff. Lymphovascular invasion should only be considered a minor criterion. Selection based on other parameters should be avoided

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Abbreviations

ENETS:

European Neuroendocrine Tumor Society

NANETS:

North American Neuroendocrine Tumor Society

aNEN:

Appendiceal neuroendocrine neoplasm

RHC:

Right hemicolectomy

RD:

Risk difference

N+:

Node positive

NNT:

Number needed to treat

NNH:

Number needed to harm

LHH:

Likelihood of being helped or harmed

WHO:

World Health Organization

95% CI:

95% Confidence interval

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

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Authors and Affiliations

  1. Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Claudio Ricci, Carlo Ingaldi, Laura Alberici, Davide Campana, Francesco Minni & Riccardo Casadei

  2. NET Team Bologna—ENETS Center of Excellence, S.Orsola-Malpighi Hospital, Bologna, Italy

    Claudio Ricci, Carlo Ingaldi, Laura Alberici, Nicole Brighi, Donatella Santini, Cristina Mosconi, Valentina Ambrosini, Davide Campana, Francesco Minni & Riccardo Casadei

  3. Department of Specialized Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Nicole Brighi & Valentina Ambrosini

  4. Histopathological Unit, Department of Diagnostic & Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy

    Donatella Santini

  5. Radiology Unit, Department of Diagnostic & Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy

    Cristina Mosconi

Authors
  1. Claudio Ricci
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  2. Carlo Ingaldi
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  3. Laura Alberici
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  4. Nicole Brighi
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  8. Davide Campana
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  9. Francesco Minni
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  10. Riccardo Casadei
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Correspondence to Claudio Ricci.

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Presented as poster at the 16th Annual Meeting of the European Neuroendocrine Tumor Society 6–8 March 2019.

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Ricci, C., Ingaldi, C., Alberici, L. et al. Histopathological diagnosis of appendiceal neuroendocrine neoplasms: when to perform a right hemicolectomy? A systematic review and meta-analysis. Endocrine 66, 460–466 (2019). https://doi.org/10.1007/s12020-019-01984-z

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  • DOI: https://doi.org/10.1007/s12020-019-01984-z

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