From the Research
Low-grade appendiceal mucinous neoplasm (LAMN) found incidentally during appendectomy for appendicitis typically requires no additional treatment if completely resected with negative margins. The appendectomy itself is usually curative for LAMN confined to the appendix without evidence of perforation or mucin outside the appendix. However, follow-up surveillance is recommended with CT scans of the abdomen and pelvis every 6-12 months for the first 2 years, then annually for up to 5 years to monitor for potential recurrence or development of pseudomyxoma peritonei, as supported by the study 1. Tumor markers such as CEA, CA-19-9, and CA-125 may be checked periodically as part of surveillance.
If there was perforation, mucin spillage, positive margins, or evidence of peritoneal spread during the initial surgery, referral to a peritoneal surface oncology specialist is warranted as more extensive surgery such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) might be necessary. The prognosis for contained LAMN is excellent, with 5-year survival rates exceeding 95%, as reported in the study 1. This approach balances the typically indolent nature of LAMN with appropriate vigilance for the small risk of progression to pseudomyxoma peritonei, which occurs in approximately 5-10% of cases.
Key considerations in the management of LAMN include:
- Complete resection with negative margins is crucial for optimal outcomes
- Surveillance with CT scans and tumor markers is essential for early detection of recurrence or pseudomyxoma peritonei
- Referral to a specialist is necessary in cases with high-risk features such as perforation or positive margins
- The prognosis for contained LAMN is excellent, with high 5-year survival rates, as demonstrated in the study 1.
It's worth noting that the provided studies 2, 3, 4, and 5 do not directly address the treatment of LAMN, but study 1 provides valuable insights into the long-term results of LAMN treatment, supporting the recommended approach.