Incidence, Treatment and Survival of Appendiceal Tumors: A Retrospective Study

Abstract

This study was made to determine the clinical and pathological features and incidences of tumors according to the results obtained from the samples taken during an appendectomy, to evaluate the post-diagnosis treatments and the survival time of patients. The data of this retrospective study had from the files of 4813 patients who were operated with pre-diagnosis of acute appendicitis at Ankara Atatürk Training and Research Hospital between 2007,-2017. Fifteen (0.31%) of the patients who underwent appendectomy were detected to have appendix tumors. According to the histopathological classification of tumors of these patients, it was determined that 8 of them had a carcinoid tumor, 6 of them had mucinous adenocarcinoma and 1 of them had adenocarcinoma. The mean age of the patients with carcinoid tumor was 30.29 ± 7.95 and the mean age of the patients with mucinous adenocarcinoma was 65 ± 18.81. It has been determined that women develop two times more appendix tumors than men. Nine patients with a tumor diameter less than 1 cm had only appendectomy operation and it was determined that tumors did not recurrence after the follow-up. Three patients with postoperative mesoappendix involvement underwent right hemicolectomy in the second operation. Preoperative computed tomography revealed periappendicular mass in 3 patients. In addition to right hemicolectomy, omentectomy, peritonectomy and lymph node dissection were performed in these three patients with suspected malignancy. The five-year survival of patients was found to be 100.0% in patients with carcinoid tumors and 67.0% in patients with mucinous adenocarcinomas. In conclusion, the majority of appendiceal tumors in our study that were found to be more widespread in women than in men were detected incidentally. The prognosis and survival rates of patients with carcinoid tumors were better than mucinous adenocarcinomas. Therefore, to made follow-up and treatment of the patients according to the report obtained after histopathologic examination of the appendix tumor is important.

Keywords

• Appendix tumor,incidence,histopathology,carcinoid tumor,mucinous adenocarcinoma,survival

Apendiks Tümörlerinin İnsidansı, Tedavisi ve Sağ Kalım: Retrospektif Bir Çalışma

Öz

Bu araştırma, appendektomi sırasında alınan numunelerden elde edilen sonuçlara göre tümörlerin klinik ve patolojik özelliklerini ve insidanslarını belirlemek, tanılama sonrasında yapılan tedavileri ve hastaların sağ kalım sürelerini değerlendirmek amacıyla yapılmıştır. Retrospektif olarak yapılan bu araştırmanın verileri, 2007-2017 yılları arasında Ankara Atatürk Eğitim ve Araştırma Hastanesi’nde akut apandisit ön tanısıyla opere edilen 4813 hastanın dosyasından elde edilmiştir. Appendektomi yapılan hastaların 15 (%0,31)’inde appendiks tümörü olduğu saptanmıştır. Bu hastaların tümörlerinin histopatolojik sınıflandırmaya göre 8’inde karsinoid tümör, 6’sında müsinöz adenokarsinom ve 1’inde adenokarsinom olduğu belirlenmiştir. Karsinoid tümörlü hastaların yaş ortalaması 30.29±7.95, müsinöz adenokarsinomlu hastaların yaş ortalaması 65±18.81 olarak saptandı. Kadınlarda erkeklere göre iki kat daha fazla appendiks tümörünün geliştiği tespit edilmiştir. Tümör çapı 1 cm’den küçük olan 9 hastaya sadece appendektomi operasyonu yapılmış ve takipleri sonrasında tümörlerin nüks etmediği belirlenmiştir. Postoperatif mezoappendiks tutulumu olan 3 hastaya, ikinci operasyonda sağ hemikolektomi yapılmıştır. Ameliyat öncesi çekilen bilgisayarlı tomografide, 3 hastada periapendiküler kitle tespit edildi. Maligniteden şüphelenilen bu üç hastaya sağ hemikolektominin yanı sıra omentektomi, peritonektomi ve lenf nodu diseksiyonu operasyonu gerçekleştirilmiştir. Hastaların beş yıllık yaşam süresi kasinoid tümörü olanlarda %100 iken, müsinöz adeno karsinomlarda %67 olduğu saptanmıştır. Sonuç olarak, araştırmamızda kadınlarda erkeklere göre daha fazla görüldüğü saptanan appendiks tümörlerinin çoğunluğu rastlantısal olarak tespit edilmiştir. Karsinoid tümörlü olan hastaların prognozu ve hayatta kalım oranları, müsinöz adeno karsinomlulara göre daha iyi olduğu belirlenmiştir. Bu nedenle appendiks tümörün histopatolojik incelemesi sonrasında elde edilen rapora göre hastaların takibinin ve tedavisinin yapılması önemlidir.

Anahtar Kelimeler

• Appendiks tümörü,insidans,histopatoloji,karsinoid tümör,müsinöz adenokarsinom,sağ kalım

Kaynakça

1. Shenoy S. Goblet cell carcinoids of the appendix: Tumor biology, mutations and management strategies. World J Gastrointest Surg. 2016;8(10):660-9.
2. McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer. 2002;94(12):3307-12.
3. McGory ML, Maggard MA, Kang H, O'Connell JB, Ko CY. Malignancies of the appendix: beyond case series reports. Dis Colon Rectum. 2005;48:2264-71.
4. Ruoff C, Hanna L, Zhi W, Shahzad G, Gotlieb V, Saif MW. Cancer of appendix: Review of the literatures. ISRN Oncol. 2011;1-6.
5. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH. Is there truly an oncologic indication for interval appendectomy? Am J Surg. 2015;209:442-6.
6. Schwartz JA, Forleiter C, Lee D, Kim GJ. Occult appendicieal neoplasms in acute and chronic appendicitis: A single-institution experience of 1793 appendectomies. Am Surg. 2017;83(12):1381-5.
7. Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum. 1998;41(1):75-80.
8. Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol. 2006;41(8):745-9.

9. Deelder JD, Richir MC, Schoorl T, Schreurs WH. How to treat an appendiceal inflammatory mass: operatively or nonoperatively? J Gastrointest Surg. 2014;18:641-5.
10. Misdraji J. Appendiceal mucinous neoplasms: controversial issues. Arch Pathol Lab Med. 2010;134:864-70.
11. Santos D, Chiang YJ, Badgwell B. Appendicitis in cancer patients is often observed and can represent appendiceal malignancy. Am Surg. 2016;82(10):1028-32.
12. Loftus TJ, Raymond SL, Sarosi GA Jr, Croof CA, Smith RS, Efron PA, et al. Predicting appendiceal tumors among patients with appendicitis. J Trauma Acute Care Surg. 2017;82(4):771-5.
13. Ozcelik CK, Turanli S, Bozdogan N, Dibekoglu C. Clinical experience in appendiceal neuroendocrine neoplasms. Contemp Oncol (Pozn). 2015;19(5):410-3.
14. Marmor S, Portschy PR, Tuttle TM, Virnig BA. The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg. 2015;19(4):743-50.
15. Teixeira FJR Jr, Couto Netto SDD, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg. 2017;12:12.
16. Bulut T, Arduçoğlu Merter A. The retrospective analysis of 2373 appendectomy specimens. F.Ü. Sağ. Bil Tıp Derg. 2017;31(3):105-9. (in Turkish) http://tip.fusabil.org/text.php3?id=1227.
17. Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, Yilmaz S. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol. 2013;19(25):4015-22.
18. Shapiro R, Eldar S, Sadot E, Papa MZ, Zippel DB. Appendiceal carcinoid at a large tertiary center: pathologic findings and long-term follw-up evaluation. Am J Surg. 2011;201(6):805-8.
19. In’t Hof KH, van der Wal HC, Kazemier G, Lange JF. Carcinoid tumors of the appendix: an analysis of 1,485 consecutive emergency appendectomies. J Gastrointest Surg. 2008;12(8):1436-8.
20. Ozer MT, Demirbas S, Celik E, Safali M, Harlak A, Coskun K, et al. Natural behaviour and surgical treatment of appendiceal carcinoids: an analysis of 2,376 consecutive emergency appendectomies. Bratisl Lek Listy. 2011;112(11):619-22.
21. Estrozi B, Bacchi CE. Neuroendocrine tumors involving the gastroenteropancreatic tract: a clinicopathological evaluation of 773 cases. Clinics (Sao Paulo). 2011;66(10):1671-5.
22. Goede AC, Caplin ME, Winslet MC. Carcinoid tumour of the appendix. Br J Surg. 2003 Nov;90(11):1317-22.
23. Benedix F, Reimer A, Gastinger I, Mroczkowski P, Lippert H, Kube R; Study Group. Primary appendiceal carcinoma--epidemiology, surgery and survival: results of a German multi-center study. Eur J Surg Oncol. 2010;36(6):763-71.
24. Nitecki SS, Wolf BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg. 1994;219(1):51-7.
25. Orcutt ST, Anaya DA, Malafa M. Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature. Int J Surg Case Rep. 2017;37:13-6.
26. Rymer B, Forsythe RO, Husada G. Mucocoele and mucinous tumours of the appendix: A review of the literature. Int J Surg. 2015;18:132-5.
27. Padmanaban V, Morano WF, Gleeson E, Aggarwal A, Mapow BL, Stein DE, et al. Incidentally discorvered low-grade appendiceal mucinous neoplasm: a precursor to pseudomyxoma peritonei. Clin Case Rep. 2016;4(12):1112-6.