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The use of size criteria alone to determine further surgical management needs review, especially in light of new imaging techniques which enable more accurate staging and restaging.
In particular, the recommendation to proceed to a right hemi-colectomy for appendiceal tumours >2cm warrants reconsideration. There is no evidence that a right hemi-colectomy in this setting improves survival [1-3]. Moreover, the evidence base that does exist to support this approach predates modern imaging with multi-slice CT and certainly predates imaging with Ga-68 DOTA-Octreotate (GaTate) PET/CT. Early experience with GaTate PET/CT suggests that it can be very useful in this setting, as a normal study confidently excludes macroscopic residual diseas, and a conservative approach may be warranted in this setting. Conversely, an abnormal study may identify disease outside of the field that would be encompassed by a right hemicolectomy (usually peritoneal deposits) which can thereby direct more appropriate management strategies.
Dr Michael Hofman, MBBS, FRACP Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne
1. Fornaro, R., et al., Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors? Tumori, 2007. 93(6): p. 587-90. 2. Bamboat, Z.M. and D.L. Berger, Is right hemicolectomy for 2.0-cm appendiceal carcinoids justified? Arch Surg, 2006. 141(4): p. 349-52; discussion 352. 3. Groth, S.S., et al., Appendiceal carcinoid tumors: Predictors of lymph node metastasis and the impact of right hemicolectomy on survival. J Surg Oncol, 2011. 103(1): p. 39-45.