Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 10906-10920
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10906
Prognostic impact of number of examined lymph nodes on survival of patients with appendiceal neuroendocrine tumors
Rui Du, Jiang-Wei Xiao
Rui Du, Jiang-Wei Xiao, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Author contributions: Xiao JW conceived the study; Du R collected, performed, and analyzed the data, and wrote the paper; Xiao JW and Du R carried out the data statistical processing and revised the paper; and All authors reviewed the results and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the ethics committee of the First Affiliated Hospital of Chengdu Medical College.
Informed consent statement: The requirement for informed consent was waived by the committee because of the retrospective nature of the study.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang-Wei Xiao, MD, PhD, Professor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chengdu Medical College, No. 278 Baoguang Avenue, Xindu District, Chengdu 610500, Sichuan Province, China. xiaojiangwei2018@163.com
Received: March 19, 2022
Peer-review started: March 19, 2022
First decision: May 1, 2022
Revised: May 8, 2022
Accepted: August 1, 2022
Article in press: August 1, 2022
Published online: October 26, 2022
ARTICLE HIGHLIGHTS
Research background

Appendiceal neuroendocrine tumors are often confirmed by pathological examination after appendicectomy. It is unclear how many lymph nodes should be surgically removed for neuroendocrine tumors occurring in the appendix so that the patients could achieve a better survival.

Research motivation

Detailed survival rates of patients with appendiceal neuroendocrine tumors are not clear, especially for those with different disease stages and lymph statuses. The relationship between different numbers of examined lymph nodes and survival rates for appendiceal neuroendocrines tumor has not been described.

Research objectives

With data of 4583 patients with appendiceal neuroendocrine tumors, the study aimed to describe factors that could have an effect on patients survival and survival rates for different disease stages, to verify whether it is reliable to choose surgery type only according to tumor size and the relationship between tumor size and lymph metastasis, and to determine the optimal number of examined lymph nodes and the optimal lymph node positive rate for patients with appendiceal neuroendocrine tumors.

Research methods

This retrospective study included patients with appendiceal neuroendocrine tumors who underwent surgical resection in the SEER database. The clinical characteristics were described. X-tile software was used to determine the optimal cutoff points. Cancer-specific survival curves were plotted using the Kaplan–Meier method and survival differences were estimated by the log-rank test.

Research results

Blindly expanding the scope of surgical resection did not bring survival benefits. There were optimal cutoff points of examined lymph nodes and lymph node positive rate that could bring a better survival.

Research conclusions

The optimal numbers of examined lymph nodes are different according to lymph node status.

Research perspectives

More appendiceal neuroendocrine patients with tumors larger than 2 cm but undergoing local resection can be contrasted to those undergoing colectomy or greater resection in future. The optimal values of examined lymph nodes and lymph node positive rate can be further determined if more factors are taken into account.