Survival after resection of appendiceal carcinoma by hemicolectomy and less radical than hemicolectomy: a population‐based propensity score matched analysis

• Published in: Colorectal disease 2017-10, Vol.19 (10), p.895-906
• Main Authors: Elias, H., Galata, C., Warschkow, R., Schmied, B. M., Steffen, T., Post, S., Marti, L.
• Format: Article
• Language: English
• Subjects: adenocarcinoma; Aged; Aged, 80 and over; Appendiceal Neoplasms - mortality; Appendiceal Neoplasms - pathology; Appendiceal Neoplasms - surgery; Appendix; 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; prognostic factors; Propensity Score; Proportional Hazards Models; Retrospective Studies; right hemicolectomy; SEER Program; surgical technique; Survival Rate; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13746

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.