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Journals / İstanbul Tıp Fakültesi Dergisi / 2022 / Cilt: 85 Sayı: 3

SURGICAL MANAGEMENT OF APPENDIX TUMORS: A SINGLE-CENTER REVIEW OF 15 YEARS

APENDİKS TÜMÖRLERİNİN CERRAHİ TEDAVİSİ: 15 YILLIK TEK MERKEZLİ BİR İNCELEME

Safa Toprak(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0002-0544-3148
Recep Erçin Sönmez(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0003-2740-1261
Melek Büyük(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0003-3425-2137
Mehmet İlhan(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0003-1472-9401
Ali Fuat Kaan Gök(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0002-3203-1253
Mine Güllüoğlu(ISTANBUL UNIVERSITY, İSTANBUL FACULTY OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF PATHOLOGY)0000-0002-3967-0779
Cemalettin Ertekin(İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, İSTANBUL TIP PR.)0000-0002-8052-1628
Mustafa Kayıhan Günay(ISTANBUL UNIVERSITY, İSTANBUL FACULTY OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF GENERAL SURGERY)0000-0003-0354-2721
Pages
312–320
Publication Date
2022-07-06
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Malignancy (HR=3.76, p=0.036) and age (≥60) (HR=3.86, p=0.006) were significant factors of overall survival (OS).

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: Primary neoplasms of the appendix are rare and most clinicians are unfamiliar with them.
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Key Findings & Data:Materials and Methods: 4,450 patients with a history of appendectomy from January 2006 to February 2021 were analyzed retrospectively.
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Conclusion & Impact:Malignancy (HR=3.76, p=0.036) and age (≥60) (HR=3.86, p=0.006) were significant factors of overall survival (OS).
🔬Design:Araştırma Makalesi
📍Scope:2006 Verileri
⚙️Variables:Apendiks tümörleri · Hipertermik intraperitoneal kemoterapi (HIPEC) · nöroendokrin tümör

Abstract

Objective: Primary neoplasms of the appendix are rare and most clinicians are unfamiliar with them. The selected approach may differ, ranging from appendectomy to cytoreductive surgery. We aimed to present our clinical experience with the surgical management of appendix tumors. Materials and Methods: 4,450 patients with a history of appendectomy from January 2006 to February 2021 were analyzed retrospectively. Patients diagnosed with “serrated lesion/polyp, low/high-grade appendiceal mucinous neoplasm (LAMN/ HAMN), mucinous/non-mucinous/goblet cell adenocarcinoma, neuroendocrine tumor (NET)” were included in the study. Histological evaluations, surgical procedures, follow-up data, and survival outcomes were evaluated. Results: Among 132 [F:87 (65.9%)] patients diagnosed with appendix tumors, 27 (20.5%) were in the benign group (Group A), 61 (46.2%) were in the borderline group (Group B), and 44 (33.3%) were in the malignant group (Group C). Appendectomy and right hemicolectomy were performed as the initial operations in 105 (79.5%) and 27 (20.5%) patients, respectively. Seventeen patients (12.9%) with a previous history of appendectomy received right hemicolectomy (n=9; due to surgical margin positivity) and Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) (n=8; due to recurrence) as redo surgery during the follow-up period. Appendectomy was sufficient for 88 (66.6%) patients. Adenocarcinoma was revealed as a statistically significant factor for recurrence-free survival (RFS) (HR=7.28, p=0.049). Malignancy (HR=3.76, p=0.036) and age (≥60) (HR=3.86, p=0.006) were significant factors of overall survival (OS). Conclusion: Appendectomy is efficient in the treatment of appendix tumors for selected cases considering low morbidity of the procedure and favorable survival outcomes. For advanced-stage tumors, extended resections combined with chemotherapy should be the preferred approach.

Özet

Amaç: Apendiksin primer neoplazmları, çoğu klinisyenin aşina olmadığı nadir bir durumdur. Seçilen yaklaşım apendektomiden sitoredüktif cerrahiye farklılık gösterebilir. Apendiks tümörlerinin cerrahi tedavisi ile ilgili klinik deneyimimizi sunmayı amaçladık. Gereç ve Yöntem: Ocak 2006 ile Şubat 2021 arasında; apendektomi öyküsü olan 4450 hasta geriye dönük olarak incelendi. ‘Tırtıklı lezyon/polip, düşük/yüksek dereceli apendiks müsinöz neoplazm (LAMN/HAMN), müsinöz/müsinöz olmayan/goblet hücreli adenokarsinom, nöroendokrin tümör (NET)’ tanısı alan hastalar çalışmaya dahil edildi. Histolojik değerlendirmeler, cerrahi prosedürler, takip verileri ve sağkalım sonuçları değerlendirildi. Bulgular: Apendiks tümörü tanısı konan 132 [K:87 (%65.9)] hastadan; 27’si (%20,5) benign (Grup A), 61’i (%46,2) borderline (Grup B) ve 44’ü (%33,3) malign (Grup C) grupta idi. Primer operasyon olarak sırasıyla 105 (%79,5) ve 27 (%20,5) hastaya apendektomi ve sağ hemikolektomi uygulandı. Daha önce apendektomi öyküsü olan 17 hastaya (%12.9) sağ hemikolektomi (n=9; cerrahi sınır pozitifliği nedeniyle) ve Hipertermik İntraperitoneal Kemoterapi (HIPEC) ile Sitoredüktif Cerrahi (CRS) (n=8; nüks nedeniyle) sekonder cerrahi olarak uygulandı. Takip süresi boyunca 88 (%66,6) hastaya sadece apendektomi uygulandı. Adenokarsinom, nükssüz sağkalım (RFS) için istatistiksel olarak anlamlı bir faktör olarak ortaya çıktı (HR=7.28, p=0.049). Malignite (HR=3.76, p=0.036) ve yaş (≥60) (HR=3.86, p=0.006) genel sağkalımın (OS) önemli faktörleriydi. Sonuç: Apendektomi, işlemin düşük morbiditesi ve olumlu sağkalım sonuçları göz önüne alındığında, seçilmiş vakalarda apendiks tümörlerinin tedavisinde etkilidir. İleri evre tümörler için kemoterapi ile birlikte genişletilmiş rezeksiyonlar tercih edilen yaklaşım olmalıdır.

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Cite This Article

Toprak, S., Sönmez, R. E., Büyük, M., İlhan, M., Gök, A. F. K., Güllüoğlu, M., Ertekin, C., Günay, M. K., *, R. E. S. (2022). SURGICAL MANAGEMENT OF APPENDIX TUMORS: A SINGLE-CENTER REVIEW OF 15 YEARS. İstanbul Tıp Fakültesi Dergisi, Cilt: 85 Sayı: 3, 312–320. https://doi.org/10.26650/IUITFD.1094714

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