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Which is the appropriate surgical procedure for appendiceal adenocarcinoma: appendectomy, partial colectomy or right hemicolectomy?

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Abstract

Objective

The purpose of this study was to explore the appropriate surgical procedure and clinical decision for appendiceal adenocarcinoma.

Methods

A total of 1,984 appendiceal adenocarcinoma patients from 2004 to 2015 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into three groups based on the extent of surgical resection: appendectomy (N = 335), partial colectomy (N = 390) and right hemicolectomy (N = 1,259). The clinicopathological features and survival outcomes of three groups were compared, and independent prognostic factors were assessed.

Results

The 5-year OS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 58.3%, 65.5% and 69.1%, respectively (right hemicolectomy vs appendectomy, P < 0.001; right hemicolectomy vs partial colectomy, P = 0.285; partial colectomy vs appendectomy, P = 0.045). The 5-year CSS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 73.2%, 77.0% and 78.7%, respectively (right hemicolectomy vs appendectomy, P = 0.046; right hemicolectomy vs partial colectomy, P = 0.545; partial colectomy vs appendectomy, P = 0.246). The subgroup analysis based on the pathological TNM stage indicated that there was no survival difference amongst three surgical procedures for stage I patients (5-year CSS rate: 90.8%, 93.9% and 98.1%, respectively). The prognosis of patients who underwent an appendectomy was poorer than that of those who underwent partial colectomy (5-year OS rate: 53.5% vs 67.1%, P = 0.005; 5-year CSS rate: 65.2% vs 78.7%, P = 0.003) or right hemicolectomy (5-year OS rate: 74.2% vs 53.23%, P < 0.001; 5-year CSS rate: 65.2% vs 82.5%, P < 0.001) for stage II disease. Right hemicolectomy did not show a survival advantage over partial colectomy for stage II (5-year CSS, P = 0.255) and stage III (5-year CSS, P = 0.846) appendiceal adenocarcinoma.

Conclusions

Right hemicolectomy may not always be necessary for appendiceal adenocarcinoma patients. An appendectomy could be sufficient for therapeutic effect of stage I patients, but limited for stage II patients. Right hemicolectomy was not superior to partial colectomy for advanced stage patients, suggesting omission of standard hemicolectomy might be feasible. However, adequate lymphadenectomy should be strongly recommended.

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Data availability

The supportive data of this manuscript are available from the public SEER database (https://seer.cancer.gov/).

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Funding

This work was supported by the Tianjin Health Science and Technology Project (NO.ZC20213).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People’s Republic of China

    Bochao Zhao, Zhicheng Ma, Jingchao Wang, Weiqiang Wang, Tao Yang & Kewei Meng

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  1. Bochao Zhao
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  2. Zhicheng Ma
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  3. Jingchao Wang
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  4. Weiqiang Wang
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  5. Tao Yang
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  6. Kewei Meng
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Contributions

(I) Study conception and design: ZBC and MKW; (II) Data collection: ZBC and WJC; (III) Data analysis and interpretation: ZBC, MZC, WJC and WWQ; (IV). Manuscript drafting: ZBC; (V) Manuscript editing and preparation: ZBC and MZC; (VI) Manuscript review and supervision: YT and MKW. All authors read and approved the final edition of this manuscript.

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Correspondence to Bochao Zhao or Kewei Meng.

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The authors declare that they have no conflict of interest.

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Ethical approval and informed consent were waived since the data of all patients were obtained from a publicly available database.

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Zhao, B., Ma, Z., Wang, J. et al. Which is the appropriate surgical procedure for appendiceal adenocarcinoma: appendectomy, partial colectomy or right hemicolectomy?. Clin Transl Oncol 26, 297–307 (2024). https://doi.org/10.1007/s12094-023-03259-6

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  • DOI: https://doi.org/10.1007/s12094-023-03259-6

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