Survival After Resection of Appendiceal Carcinoma by Hemicolectomy and Less Radical Than Hemicolectomy: A Population-Based Propensity Score Matched Analysis

Colorectal Dis. 2017 Oct;19(10):895-906. doi: 10.1111/codi.13746.

Abstract

Aim: The operative treatment for non-metastatic appendiceal carcinoma is controversial despite the recommendation of right hemicolectomy (RH) by many researchers. The aim of this population-based study was to compare outcomes after RH and less radical resection than right hemicolectomy (LRH).

Method: A total of 1144 patients who underwent resection with additional lymphadenectomy of Stages I-III appendiceal carcinoma from 2004 to 2012 were identified in the Surveillance, Epidemiology and End Results database. Overall survival (OS) and cancer-specific survival (CSS) after RH and LRH were assessed by unadjusted and risk-adjusted Cox regression analysis and by propensity score matched analysis.

Results: A total of 855 (74.7%) patients underwent RH and 289 (25.3%) underwent LRH. In an unadjusted analysis, survival after LRH and RH did not differ in OS [hazard ratio (HR) 0.95, 95% CI 0.71-1.26, P = 0.707] and CSS (HR 0.95, 95% CI 0.69-1.32, P = 0.762). The 5-year OS and CSS in patients who underwent RH were 71.6% (95% CI 67.8-75.6%) and 76.4% (95% CI 72.8-80.3) compared with 73.8% (95% CI 67.9-80.2) and 78.7% (95% CI 73.2-84.7) in patients with LRH, respectively. No relevant difference in survival between LRH and RH could be observed in a multivariable analysis (OS, HR 0.90, 95% CI 0.65-1.25, P = 0.493; CSS, HR 0.87, 95% CI 0.60-1.26, P = 0.420) and after propensity score adjusted analysis (OS, HR 0.87, 95% CI 0.62-1.22, P = 0.442; CSS, HR 0.97, 95% CI 0.67-1.40, P = 0.883).

Conclusions: In this retrospective analysis, survival after RH for non-metastatic appendiceal carcinoma was not statistically significantly superior to LRH. Hence, LRH with lymphadenectomy might be sufficient for treatment of non-metastatic appendiceal carcinoma.

Keywords: Appendix; adenocarcinoma; prognostic factors; right hemicolectomy; surgical technique.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / surgery*
  • Carcinoma / mortality
  • Carcinoma / pathology
  • Carcinoma / surgery*
  • Colectomy / methods
  • Colectomy / mortality*
  • Female
  • Humans
  • Lymph Node Excision / methods
  • Lymph Node Excision / mortality*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Propensity Score
  • Proportional Hazards Models
  • Retrospective Studies
  • SEER Program
  • Survival Rate
  • Treatment Outcome