Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy

Bastiaenen, Vivian P.; Jonge, Jeroen de; Corten, B.J.G.A.; Lohman, Elise A J de Savornin; Kraima, Anne C.; Swank, Hilko A; Vliet, Jaap L.P. van; Acker, Gijs J.D. van; Geloven, A. A. W. van; Hof, Klaas H. in ‘t; Koens, Lianne; Reuver, Philip R. de; Rossem, Charles C. van; Slooter, Gerrit D.; Tanis, Pieter J.; Terpstra, Valeska; Dijkgraaf, Marcel G. W.; Bemelman, Willem A.

doi:10.1097/sla.0000000000005228

Cited by 3 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent audit from the UK reported that more than 100 appendiceal specimens were not reviewed by surgeons, with no significant health or medico-legal implications after the operation [ 21 ]. A multicentric prospective analysis conducted in the Netherlands [ 16 ] involving 7,339 patients, included thorough inspection and palpation of the appendix and mesoappendix by surgeons. They found that 67.7% of the specimens would have been deemed unnecessary for histopathological examination, as only 22 out of 4,966 patients had appendiceal neoplasms.…”

Section: Discussionmentioning

confidence: 99%

Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix

Hanganu,

Isswiasi,

Adigun

et al. 2024

Cureus

View full text Add to dashboard Cite

Background: Appendicectomy is the most frequently performed emergency general surgical procedure. Previous research has highlighted discrepancies between initial intraoperative laparoscopic diagnoses and subsequent histopathology reports following appendicectomy. In the United Kingdom (UK), routine histopathological examination is the established practice, ensuring precise diagnosis of appendiceal specimens. This retrospective analysis aims to compare intraoperative laparoscopic assessments of the appendix with corresponding histopathology findings. Methodology: We conducted a retrospective analysis of 418 consecutive emergency laparoscopic appendectomies at Peterborough City Hospital in the UK between April 2018 and June 2019 for suspected appendicitis. Intraoperative findings were compared with histopathological examination outcomes using kappa statistics. Results: Of the 418 appendectomies analysed, we found a substantial agreement between surgeons and pathologists (kappa = 0.71, P < 0.001) in detecting overall abnormalities of appendices. This agreement was also high for detecting inflamed appendices (kappa = 0.72, P < 0.001). However, of the six neoplastic lesions confirmed in the pathologists' final report, only two were suspected during laparoscopy. Conclusions: While laparoscopic assessments of the appendix demonstrate a statistically significant and improved agreement with histopathological findings in detecting abnormal and inflamed appendices, the ability of surgeons to identify neoplasia appears suboptimal based on our small sample of neoplasia cases. The data strongly support the continued practice of routine histopathological examination following appendicectomy due to its crucial role in avoiding missed diagnoses and ensuring better patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix

Hanganu,

Isswiasi,

Adigun

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Two systematic reviews published in 2011 and 2020 stated that it is impossible to conclude whether routine histopathology is justified but recommended that until more reliable data becomes available, histopathological examination of the removed appendix should continue to be carried out ( 20 , 21 ). However, Bastiaenen et al ( 24 ), in a multicenter, prospective, cross-sectional study with 7,339 patients submitted to appendectomy for suspected appendicitis, found robust evidence that selective histopathological examination of appendiceal specimens following the initial macroscopic evaluation by the surgeon was oncologically safe and could lead to significant cost savings. Our findings align with these conclusions, demonstrating significant limitations of the routine histopathological analysis, with a low agreement with the intraoperative severity classification, lack of association with post-operative outcomes, and low incidence of associated etiologies.…”

Section: Discussionmentioning

confidence: 99%

Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome

et al. 2022

View full text Add to dashboard Cite

IntroductionSome studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.ObjectiveTo investigate the agreement between histopathological and intraoperative classifications for pediatric appendicitis and evaluate the predictive potential of these classifications for the post-operative outcome.MethodsA retrospective, longitudinal, observational single-center study, carried out with 485 patients up to15 years of age, with a confirmed diagnosis of acute appendicitis by histopathological evaluation. The histopathological results classified the appendices as uncomplicated appendicitis when there was confirmation of the diagnosis of appendicitis without necrosis or perforation and complicated appendicitis when there was extensive necrotic tissue in the outer layer of the appendix or signs of perforation. The intraoperative findings were classified as uncomplicated appendicitis when the appendix presented with hyperemia and edema or fibrinous exudate and complicated appendicitis when the appendix showed necrosis, abscess, or perforation. The kappa index determined the agreement and the prediction relationships using a generalized linear model.Results43.9% of cases were classified as complicated appendicitis by histopathological evaluation and 49.7% by intraoperative classification. The agreement analysis between the histopathological and intraoperative classification showed a moderate agreement, with a Kappa index of 0.419 (0.337–0.501). There was an association (P < 0.05) between the intraoperative classification and the post-operative clinical outcomes (time to start feeding, fever, intraabdominal collection, length of stay, the need for antibiotic therapy changing, and need for ICU). There was no association between histopathological classification and post-operative outcomes.ConclusionThe agreement between the two classifications was moderate, and the intraoperative classification was able to predict the post-operative clinical outcomes.

show abstract

Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study

Tavra,

Quien,

Barcot

2023

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy

Cited by 3 publications

References 24 publications

Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix

Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix

Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome

Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study

Contact Info

Product

Resources

About