Abstract
Background
The treatment algorithm for appendiceal carcinoids is based on tumor size. We wanted to verify whether right hemicolectomy confers a survival advantage compared with appendectomy in patients with tumors larger than 2 cm.
Methods
Data regarding patients with primary carcinoid tumors of the appendix were collected from the Surveillance, Epidemiology, and End Results program database. A propensity score with respect to surgical intervention was calculated with a binary logistic regression including gender, stage of disease, and age as covariates. The groups were matched with a 1:1 ratio, using the nearest neighbor algorithm. A Cox proportional hazards model adjusted for propensity score was implemented to assess the impact of surgical intervention on overall survival.
Results
Only stage of disease differed between the groups (p = 0.011). After matching, based on the propensity score, our series was constituted of 109 patients undergoing appendectomy and 109 undergoing right hemicolectomy. The type of surgical intervention failed to reach statistical significance.
Conclusions
Right hemicolectomy did not seem to confer any survival advantage on patients with appendiceal carcinoids with a diameter >2 cm. For this reason, tumor size should not be considered an absolute indication for right hemicolectomy.
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References
Moertel CG, Dockerty MB, Judd ES (1968) Carcinoid tumors of the vermiform appendix. Cancer 21:270–278
Moertel CG, Weiland LH, Nagorney DM, Dockerty MB (1987) Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med 317:1699–1701
The SEER Program Coding and Staging Manual 2004. The SEER Program Coding and Staging Manual 2004. [Online] http://seer.cancer.gov/archive/manuals/2004Revision1/SPM_2004_maindoc.r1.pdf
Appendix C—Site Specific Coding Modules. SEER Program Coding and Staging Manual 2013. [Online] February 2013. http://seer.cancer.gov/manuals/2013/appendixc.html
Rubin D (2006) Matched sampling for casual effects. Cambridge University Press, Cambridge
Sekhon JS (2011) Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw 42:1–52
Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55
Ho D, Imai K, King G, Start E (2007) Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Polit Anal 15:199–236
Ho D, Imai K, King G, Stuart E (2011) Matchit: nonparametric preprocessing for parametric causal inference. J Stat Softw 42:1–28
Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107
Groth SS, Virnig BA, Al-Refaie WB et al (2011) Appendiceal carcinoid tumors: predictors of lymph node metastasis and the impact of right hemicolectomy on survival. J Surg Oncol 103:39–45
Stinner B, Kisker O, Zielke A et al (1996) Surgical management for carcinoid tumors of small bowel, appendix, colon and rectum. World J Surg 20:183–188
Bamboat ZM, Berger DL (2006) Is right hemicolectomy for 2.0-cm appendiceal carcinoids justified? Arch Surg 141:349–352
McCusker ME, Cote TR, Clegg LX et al (2002) Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 94:3307–3312
McGory ML, Maggard MA, Kang H et al (2005) Malignancies of the appendix: beyond case series reports. Dis Colon Rectum 48:2264–2271
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Ciarrocchi, A., Pietroletti, R., Carlei, F. et al. Propensity adjusted appraisal of the surgical strategy for appendiceal carcinoids. Tech Coloproctol 19, 35–41 (2015). https://doi.org/10.1007/s10151-014-1249-2
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DOI: https://doi.org/10.1007/s10151-014-1249-2