From the Research
Low grade mucinous appendiceal neoplasms (LAMNs) typically do not require adjuvant therapy after complete surgical resection, as supported by the most recent study 1 published in 2023. The standard management for these tumors is surgical removal, usually through appendectomy or right hemicolectomy depending on the extent of disease.
- For confined LAMN (pT1-3), observation with regular surveillance is recommended rather than adjuvant chemotherapy, as indicated by the study 2 published in 2025.
- If there is evidence of peritoneal spread (pseudomyxoma peritonei), the treatment approach shifts to cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), as suggested by the study 3 published in 2017. HIPEC typically uses mitomycin C (15-40 mg/m²) or oxaliplatin (300-460 mg/m²) administered at 41-43°C for 30-90 minutes during surgery.
- The lack of benefit from adjuvant systemic chemotherapy for low-grade appendiceal mucinous neoplasms is due to their indolent biological behavior and limited cellular proliferation, making them relatively resistant to conventional chemotherapy agents, as demonstrated by the study 1. Follow-up should include regular clinical examinations, tumor markers (CEA, CA-19-9, CA-125), and CT scans every 6-12 months for at least 5 years to monitor for recurrence or peritoneal spread, as recommended by the study 4 published in 2021. The management of LAMN is variable, and long-term data and identification of prognostic features are necessary to generate consensus on the optimal management of these complex patients, as highlighted by the study 4. The current evidence suggests that surgical removal with or without HIPEC is the most effective treatment approach for LAMNs, and adjuvant systemic chemotherapy is not recommended, as supported by the study 1.