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A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs.

Objective

The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs.

Methods

We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence.

Results

We identified 217 patients with localized LAMNs. Median age was 59 years (11–95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0–271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5–47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence.

Conclusions

This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.

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Author information

Author notes

  1. Joel M. Baumgartner and Amitabh Srivastava have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Joel M. Baumgartner MD, MAS, Kaitlyn J. Kelly MD, Jula Veerapong MD & Andrew M. Lowy MD

  2. Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Amitabh Srivastava MD & Phoenix Bell MD

  3. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Nelya Melnitchouk MD

  4. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Michael G. Drage MD, PhD & Aaron R. Huber DO

  5. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Raul S. Gonzalez MD

  6. Department of Pathology and Laboratory Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA

    Elizabeth Wu MD & Murray Resnick MD

  7. Department of Surgery, University of Chicago, Chicago, IL, USA

    Kiran Turaga MD, MPH & Elizabeth Poli MD

  8. Department of Surgery, Frederick Health Hospital, Frederick, MD, USA

    Jesus Esquivel MD

  9. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Jeremiah Deneve DO

Authors
  1. Joel M. Baumgartner MD, MAS
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  2. Amitabh Srivastava MD
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  3. Nelya Melnitchouk MD
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  4. Michael G. Drage MD, PhD
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  6. Raul S. Gonzalez MD
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  8. Elizabeth Wu MD
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  9. Murray Resnick MD
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  10. Kiran Turaga MD, MPH
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  11. Elizabeth Poli MD
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  12. Jesus Esquivel MD
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  13. Jeremiah Deneve DO
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  14. Kaitlyn J. Kelly MD
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  15. Jula Veerapong MD
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  16. Andrew M. Lowy MD
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Corresponding author

Correspondence to Joel M. Baumgartner MD, MAS.

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Baumgartner, J.M., Srivastava, A., Melnitchouk, N. et al. A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 28, 4685–4694 (2021). https://doi.org/10.1245/s10434-020-09499-y

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  • DOI: https://doi.org/10.1245/s10434-020-09499-y

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