Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding
Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding
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DOI：
10.1002/bjs.4393
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发表时间：
2004-03-01
影响因子：
9.6
通讯作者：
Sugarbaker, PH
中科院分区：
文献类型：
--
作者：
González-Moreno, S;Sugarbaker, PH
背景：传统上，阑尾上皮恶性肿瘤伴或不伴癌变均采用右半结肠切除术治疗。最近大量患者的积累使得重新评估这种手术判断成为可能。方法：回顾性分析501例阑尾上皮性恶性肿瘤的临床资料。所有患者在转诊时都进行了腹膜播种，并接受了细胞减少手术和围手术期腹腔化疗。统计分析的主要自变量是用于切除原发癌的手术程序（单独阑尾切除术与右半结肠切除术）。另外19个临床和病理变量作为控制变量。所有分析的终点都是生存。结果：初诊后中位随访时间为4年。局部淋巴结阳性率为5.0%。根据组织学类型确定淋巴结转移的发生率时，肠肿瘤（66.7%）高于粘液肿瘤（4.2%）（P < 0.001）。有无淋巴结转移对预后无影响（P = 0.155）。单因素分析显示，手术（单独阑尾切除术与右半结肠切除术）对患者生存有影响（P < 0.001），但多因素分析没有影响（P = 0.258）。结论：右半结肠切除术对腹膜播种的粘液性阑尾肿瘤患者没有生存优势。这些数据表明，除非活检证实阑尾或回肠结肠远端淋巴结转移受累，或者切除范围不够，否则应避免行紧密半结肠切除术。
Background: Traditionally epithelial malignancies of the appendix with or without carcinomatosis have been treated by right hemicolectomy. Recent accumulation of a large number of patients with this disease has enabled a re-evaluation of this surgical judgement.Methods: Clinical data on 501 patients with epithelial malignancy of the appendix were collected prospectively. All patients had peritoneal seeding at the time of referral and were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. The main independent variable for statistical analysis was the surgical procedure used to resect the primary cancer (appendicectomy alone versus right hemicolectomy). Nineteen other clinical and pathological variables were considered as control variables. The endpoint for all analyses was survival.Results: Median follow-up after the initial diagnosis was 4 years. The rate of regional lymph node positivity was 5.0 per cent. When the incidence of lymph node metastasis was determined by histological type, it was statistically significantly higher in intestinal (66.7 per cent) than in mucinous (4.2 per cent) tumours (P < 0.001). The presence of lymph node metastases had no influence on prognosis (P = 0.155). The surgical procedure (appendicectomy alone versus right hemicolectomy) had an influence on patient survival by univariate analysis (P < 0.001), but not by multivariate analysis (P = 0.258).Conclusion: Right hemicolectomy does not confer a survival advantage in patients with mucinous appendiceal tumours with peritoneal seeding. These data suggest that tight hemicolectomy should be avoided unless metastatic involvement of the appendiceal or distal ileocolic lymph nodes is documented by biopsy, or the resection margin is inadequate.