The Importance of Appendectomy in Surgery for Mucinous Adenocarcinoma of the Ovary
The Importance of Appendectomy in Surgery for Mucinous Adenocarcinoma of the Ovary
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DOI：
10.1097/igc.0000000000000910
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发表时间：
2017-03-01
影响因子：
4.8
通讯作者：
Hogdall, Claus Kim
中科院分区：
文献类型：
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作者：
Rosendahl, Mikkel;Oester, Laura Amalie Haueberg;Hogdall, Claus Kim
目的：本研究的目的是评估阑尾切除术在粘液性卵巢癌手术中的重要性。原发性卵巢癌和原发性阑尾癌在临床上、组织学上和组织化学上很难区分。切除阑尾可能有助于鉴别诊断，改善分期，并可能增加5年生存率，但也可能与术后发病率增加有关。在最大的人口出版的日期，我们分析和讨论these matters.Methods：Propioneer收集的数据269例确诊卵巢粘液腺癌从国家数据库进行了分析。阑尾切除术和阑尾转移对5年和总生存率的影响进行了analysed.Results：阑尾切除术进行了172例（64%），在10例（4%），切除阑尾的病理评估显示卵巢癌转移。其中3例肉眼检查正常，仅在显微镜检查时发现转移。阑尾转移患者的5年生存率（22%）显著低于无转移患者（73%）（χ 2 = 31.998，P < 0.0001）。同样，行子宫切除术、网膜切除术、双侧输卵管卵巢切除术和阑尾切除术的患者5年生存率显著较高（74% vs 52%，chi（2）= 7.322，P = 0.007）。在多变量分析中，修订的2013年国际妇产科联合会分类分期（IA参考）的增加与预后恶化显著相关（风险比，1.13; P < 0.0001）。同样，体力状态评分的每一个逐步增加与预后不良相关，风险比为1.63（P < 0.0001）。转移到阑尾和分期没有保持生存的重要因素在多变量analysis.Conclusions：单变量分析表明，转移性疾病的阑尾和未能执行完整的分期，包括阑尾切除术与预后恶化。外观正常的阑尾并不排除转移性疾病，因为阑尾切除术很容易进行，不会增加发病率，它应该在怀疑粘液性卵巢癌的手术中进行。
Objective: The aim of this study was to assess the importance of appendectomy during surgery for mucinous ovarian cancer. It can be difficult to distinguish between primary ovarian and primary appendiceal cancers clinically, histologically, and immunohistochemically. Removal of the appendix may facilitate differential diagnosis, improve staging, and possibly increase 5-year survival but may also be associated with increased postsurgical morbidity. In the largest population published to date, we analyze and discuss these matters.Methods: Prospectively gathered data on 269 patients with confirmed mucinous ovarian adenocarcinoma from a national database were analyzed. The impact of appendectomy and metastases to the appendix on 5-year and overall survival was analyzed.Results: Appendectomy was performed in 172 cases (64%), and in 10 cases (4%), pathologic evaluation of the removed appendix revealed metastases from ovarian cancer. Three of the cases were macroscopically normal, and metastases were discovered only during microscopic evaluation. Patients with metastatic disease to the appendix had significantly worse 5-year survival (22%) compared with patients without metastases (73%) (chi(2) = 31.998, P < 0.0001). Equally, 5-year survival was significantly higher in patients who had been adequately staged with hysterectomy, omentectomy, bilateral salpingo-oophorectomy, and appendectomy (74% vs 52%, chi(2) = 7.322, P = 0.007). In multivariate analysis, increase in revised 2013 International Federation of Gynecology and Obstetrics classification stage (IA reference) was significantly associated with worsened prognosis (hazard ratio, 1.13; P < 0.0001). Equally, each stepwise increase in performance status score was related to a poorer prognosis with hazard ratio of 1.63 (P < 0.0001). Metastases to the appendix and staging did not remain significant factors of survival in multivariate analysis.Conclusions: Univariate analysis suggests that metastatic disease to the appendix and failure to perform complete staging including appendectomy are related to a worsened prognosis. A normal-looking appendix does not exclude metastatic disease, and because appendectomy is easily performed and does not increase morbidity, it should be performed during surgery for suspected mucinous ovarian cancer.