Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases

Abstract

Purpose: A diagnostic and treatment strategy for appendiceal tumors (ATs) has not been established. We aimed to evaluate our treatment strategy for ATs including laparoscopic surgery (LS) and to identify preoperative malignancy predictors.Methods: A total of 51 patients were retrospectively reviewed. Data including tumor markers and imaging ndings were compared between carcinoma and non-carcinoma patients. Validity of planned operation was evaluated based on pathological diagnosis.Results: Twenty-ve patients were diagnosed with carcinoma, 13 with low-grade mucinous neoplasm, and 13 with other diseases. Symptoms were more commonly present in carcinoma patients than in non-carcinoma patients (68.0% vs. 23.1%, p=0.001). Elevated CEA and CA19-9 were more frequently observed in carcinoma patients than in non-carcinoma patients (p<0.01 and p=0.04, respectively). Five carcinoma patients had malignancy on biopsy, compared with zero non-carcinoma patients. Signi cant differences were noted in the percentages of carcinoma and non-carcinoma patients with solid enhanced mass (41.7% vs. 0%, p<0.001) and tumor wall irregularity (16.7% vs. 0%, p=0.03) on imaging. Although the sensitivity was not high, the speci city and positive predictive value of these ndings were 100%. Forty-two patients (82.4%) underwent LS as minimally invasive exploratory tool and/or radical operation, of whom 2 were converted to open surgery for invasion of adjacent organ. None of the patients had intraoperative complications or postoperative mortality.Conclusion: Clinical symptoms, elevated tumor markers, and worrisome features of solid enhanced mass and tumor wall irregularity on imaging can be malignancy predictors. For management of AT patients, LS is feasible and useful for diagnosis and treatment.Recently, the number of procedures involving laparoscopic surgery (LS) has been increasing in a variety of surgical elds [13]. Several studies reported that LS can be used for safe and radical resection of CRC and appendiceal tumors [14]. LS may have advantages of not only reduced invasiveness but also utility as an intraoperative diagnostic tool for cases without a de nite preoperative diagnosis.The aim of this study was to determine malignancy predictors using clinical data and preoperative imaging ndings for patients with appendiceal tumors, and to evaluate the validity of performed operations based on the preoperative and postoperative diagnosis. We also discuss the usefulness of LS for appendiceal tumors and review our surgical treatment strategy for appendiceal tumors. Methods

Prevalence of, Subtypes of, and the Role of Age in Incidental Appendiceal Neoplasms in Acute Appendicitis: A Single-Institute Study from Bahrain

“…Tumor markers, including CEA, CA19-9, CA-125, chromogranin-A, and/or 5-HIAA, may help reach the diagnosis of ANs if significantly elevated [ 29 , 30 ]. Though they are requested more frequently after postoperative diagnosis.…”

Appendiceal neoplasms—A practical guide

“…As mucinous deposits can be a common presentation of a subset of ANs, any palpable fluid-filled structures should raise the suspicion of a more advanced disease state. 8,[11][12][13] Tumor markers, including CEA, CA19-9, CA-125, chromogranin-A, and/or 5-HIAA, may be elevated, [14][15][16] though these markers are generally utilized more frequently after definitive diagnosis is made.…”

Case report: A rare case of coexistence of low-grade appendiceal mucinous neoplasia and goblet cell adenocarcinoma in the appendix

“…Ultrasound scans and/or computed tomography (CT) are effective in detecting appendiceal tumors. Ultrasound and CT scans revealing enhanced masses and irregularly thickened walls can be indicators of malignancy ( 6 ).…”