Right Hemicolectomy for Low-Grade Appendiceal Mucinous Neoplasm (LAMN). Is it Necessary?

Abstract Background Low-grade appendiceal mucinous neoplasms (LAMN) are rare appendiceal tumors characterized by a wide spectrum of clinical presentations and prognoses. Although the prognosis for LAMNs confined to the appendix is generally favourable, there remains a potential risk of progression to pseudomyxoma peritonei (PMP) and metastases. Historically, this risk has often led to extensive surgical resections for localized LAMNs, including ileocecectomy or right hemicolectomy. The rarity of these neoplasms has contributed to the absence of standardized surgical management guidelines, often leaving decisions to the surgeon’s discretion. Aims The aim of this study was to assess the necessity of performing a right hemicolectomy in the management of localized LAMNs. Methods A comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science and Google Scholar databases to identify articles reporting cases of localized LAMNs treated with right hemicolectomy and with histopathological assessment of lymph node status. Studies involving cases without right hemicolectomy, with PMP or tumors other than LAMN, or lacking lymph node involvement data were excluded. Results A total of 21 articles published between 2009 and 2024 were included, reporting 99 cases of right hemicolectomy (44% open, 28% laparoscopic, 28% not reported). None of the cases had lymph node involvement upon histopathological examination. Only one patient underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after the right hemicolectomy. Conclusion This is the largest systematic review of localized LAMNs treated with right hemicolectomy and with histopathological assessment of lymph node status. Based on our results, right hemicolectomy may not be necessary in the treatment of these tumors.