Claudio Ricci1,2, Carlo Ingaldi3,4, Laura Alberici3,4, Nicole Brighi4,5, Donatella Santini4,6, Cristina Mosconi4,7, Valentina Ambrosini4,5, Davide Campana3,4, Francesco Minni3,4, Riccardo Casadei3,4. 1. Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy. claudiochir@gmail.com. 2. NET Team Bologna-ENETS Center of Excellence, S.Orsola-Malpighi Hospital, Bologna, Italy. claudiochir@gmail.com. 3. Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy. 4. NET Team Bologna-ENETS Center of Excellence, S.Orsola-Malpighi Hospital, Bologna, Italy. 5. Department of Specialized Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy. 6. Histopathological Unit, Department of Diagnostic & Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy. 7. Radiology Unit, Department of Diagnostic & Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy.
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.
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.
Authors: José Luis Muñoz de Nova; Jorge Hernando; Miguel Sampedro Núñez; Greissy Tibisay Vázquez Benítez; Eva María Triviño Ibáñez; María Isabel Del Olmo García; Jorge Barriuso; Jaume Capdevila; Elena Martín-Pérez Journal: World J Gastroenterol Date: 2022-04-07 Impact factor: 5.374
Authors: Thomas Zheng Jie Teng; Xuan Rong Thong; Kai Yuan Lau; Sunder Balasubramaniam; Vishal G Shelat Journal: World J Gastrointest Surg Date: 2021-11-27