Editing Appendiceal neoplasms (section)

=== '''Management of mucinous neoplasms''' ===
* Initial management of radiographically or operatively diagnosed lesions:
** Localised appendiceal mucinous lesions - surgical resection with excision of mesoappendix
** Complicated radiographic mucocoele (involvement of TI or caecum or lymphadenopathy) - may require a more extensive surgical resection including right hemicolectomy and lymphadenectomy
** Ruptured appendiceal mucinous neoplasm - remove the appendix +/- right hemicolectomy, but leave formal cytoreductive surgery to high-volume surgeons. Thoroughly irrigate the abdomen.
** Disseminated intra-peritoneal disease - no need to do appendicectomy. Get a biopsy specimen, possibly percutaneously.
* Post-histology management:
** Completely resected LAMN or HAMN: no right hemicolectomy, provided the tumour was confined to the appendix and has not ruptured
** Microscopically positive margin for a LAMN: controversial. Safest thing to do is an ileocaecectomy. Observation is also justified. Right hemicolectomy is not required.
** T4a LAMN or HAMN: no consensus. Right hemicolectomy does not offer any benefit. Patients should probably be followed with regular imaging and tumour markers for PMP. CRS and HIPEC will be required once PMP is identified.
** Completely resected mucinous adenocarcinoma: controversial. UTD says offer completion right hemicolectomy and lymphadenectomy to those with only grade 2 or 3 adenocarcinoma.
** Incompletely resected mucinous adenocarcinoma: completion right hemicolectomy.
* Metastatic mucinous adenocarcinoma - CRS + HIPEC (see separate topic)
* Metastatic mucinous neoplasm - should be referred to a specialised centre for possible cytoreductive surgery and HIPEC (see separate topic)



[[Category:Colorectal]]