Role of colectomy in the management of appendiceal tumors: a retrospective cohort study

Authors

Victoria A. Marks, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.
Daniel Kerekes, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.Follow
Samuel Butensky, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.Follow
Nita Ahuja, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.Follow
Caroline Johnson, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA.Follow
Kiran Turaga, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.
Sajid A. Khan, Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA. Sajid.khan@yale.edu.Follow

Document Type

Article

Publication Title

BMC gastroenterology

Abstract

BACKGROUND: Appendiceal tumors represent a range of histologies that vary in behavior. Recommendations for treatment with appendectomy versus right hemicolectomy (RHC) for different tumor types are evolving and sometimes conflicting. This study sought to characterize variation in the United States around surgical treatment of major appendiceal tumor types over time and describe differences in outcomes based on procedure. METHODS: Patients diagnosed with appendiceal goblet cell adenocarcinoma (GCA), mucinous adenocarcinoma, neuroendocrine neoplasm (NEN), or non-mucinous adenocarcinoma from 2004-2017 were identified in the National Cancer Database. Trends in RHC over time and predictors of RHC were identified. Surgical outcomes for each histologic type and stage were compared. RESULTS: Of 18,216 patients, 11% had GCAs, 34% mucinous adenocarcinoma, 31% NENs, and 24% non-mucinous adenocarcinoma. Rate of RHC for NEN decreased from 68% in 2004 to 40% in 2017 (p = 0.008) but remained constant around 60-75% for other tumor types. Higher stage was associated with increased odds of RHC for all tumor types. RHC was associated with higher rate of unplanned readmission (5% vs. 3%, p < 0.001) and longer postoperative hospital stay (median 5 days vs. 3 days, p < 0.001). On risk-adjusted analysis, RHC was significantly associated with increased survival versus appendectomy for stage 2 disease of all tumor types (HRs 0.43 to 0.63) and for stage 1 non-mucinous adenocarcinoma (HR = 0.56). CONCLUSIONS: Most patients with appendiceal tumors undergo RHC, which is associated with increased readmission, longer length of stay, and improved survival for stage 2 disease of all types. RHC should be offered selectively for appendiceal tumors.

First Page

398

DOI

10.1186/s12876-023-03019-4

Publication Date

11-17-2023

Recommended Citation

Marks, Victoria A.; Kerekes, Daniel; Butensky, Samuel; Ahuja, Nita; Johnson, Caroline; Turaga, Kiran; and Khan, Sajid A., "Role of colectomy in the management of appendiceal tumors: a retrospective cohort study" (2023). Surgery. 235.
https://scholar.bridgeporthospital.org/surgery/235

Identifier

37978348 (pubmed); PMC10655451 (pmc); 10.1186/s12876-023-03019-4 (doi); 10.1186/s12876-023-03019-4 (pii)