Abstract：
OBJECTIVE: To investigate the long-term prognosis of appendiceal tumours incidentally detected at appendicectomy for suspicion of benign appendicitis.
METHODS: A retrospective register-based single centre cohort study was carried out, using data from the local acute appendicectomy quality register of cases operated on at the Department of Surgery, South General Hospital, Stockholm, Sweden. The local colorectal cancer register was also used to identify appendix tumours. The study period was between January 2004 and January 2023. Survival was calculated according to the Kaplan-Meier method.
RESULTS: A total of 11,888 patients were registered in the acute acute appendicectomy register, 54% males and 46% females, median age 32 (Q1 = 21, Q3 = 47) (with 33.7% were 41 years or older). From the appendicectomy and colorectal registers 148 (1.2% of the total cohort) appendiceal tumours were found; 60% in females and 40% in males, median age 56 (Q1 = 43, Q3 = 70) (with 78.4% being 41 years or older). Tumours found were: Low grade Appendiceal Mucinous Neoplasms (LAMN, N = 64); Neuroendocrine Tumours (NET N = 24); adenocarcinomas or other form of carcinomas (N = 57); and adenomas (N = 3). The overall 5-year survival in patients operated for LAMN was 96.8%, for NET 93.3% and for adenocarcinoma 69.7%. The overall 5-year survival for all tumour patients was 85.7%. For the younger patients (< 51 years) with LAMN and NET, almost all survived to the end of follow-up. Survival of patients in the carcinoma group was statistically significantly lower than for the LAMN and NET groups, especially in females 51 years or older. In the group of tumour patients undergoing surgery (n = 146), primary surgery was laparoscopic in 47% and open in 52%. Two patients did not undergo surgery due to widespread disease. In 64% of cases operation was acute, whereas it was delayed and/or planned in 34%. Most procedures were laparoscopic appendicectomy 36%, followed by open appendicectomy 30%, right-sided hemicolectomy 14.6% (open 11.6% and laparoscopic 3%, acute operation 5.5%), ileocaecal resection 5% (acute operation 3.4%), and staging laparoscopy 7%. In 38% of the operated patients the tumour was discovered incidentally at histopathology examination. Two patients had CRS and HIPEC as the initial operation. Forthy-three per cent of the 146 tumour patients operated underwent a second procedure: CRS and HIPEC in 23.3% and right-sided hemicolectomy in 13.6% (laparoscopic 8.2% open 5.4%).
CONCLUSIONS: Survival was high for patients with incidentally detected appendiceal LAMN or NET, but not so for carcinoma. Survival was lower in the carcinoma group older than 50 years, especially those sick and females.
METHODS: A retrospective register-based single centre cohort study was carried out, using data from the local acute appendicectomy quality register of cases operated on at the Department of Surgery, South General Hospital, Stockholm, Sweden. The local colorectal cancer register was also used to identify appendix tumours. The study period was between January 2004 and January 2023. Survival was calculated according to the Kaplan-Meier method.
RESULTS: A total of 11,888 patients were registered in the acute acute appendicectomy register, 54% males and 46% females, median age 32 (Q1 = 21, Q3 = 47) (with 33.7% were 41 years or older). From the appendicectomy and colorectal registers 148 (1.2% of the total cohort) appendiceal tumours were found; 60% in females and 40% in males, median age 56 (Q1 = 43, Q3 = 70) (with 78.4% being 41 years or older). Tumours found were: Low grade Appendiceal Mucinous Neoplasms (LAMN, N = 64); Neuroendocrine Tumours (NET N = 24); adenocarcinomas or other form of carcinomas (N = 57); and adenomas (N = 3). The overall 5-year survival in patients operated for LAMN was 96.8%, for NET 93.3% and for adenocarcinoma 69.7%. The overall 5-year survival for all tumour patients was 85.7%. For the younger patients (< 51 years) with LAMN and NET, almost all survived to the end of follow-up. Survival of patients in the carcinoma group was statistically significantly lower than for the LAMN and NET groups, especially in females 51 years or older. In the group of tumour patients undergoing surgery (n = 146), primary surgery was laparoscopic in 47% and open in 52%. Two patients did not undergo surgery due to widespread disease. In 64% of cases operation was acute, whereas it was delayed and/or planned in 34%. Most procedures were laparoscopic appendicectomy 36%, followed by open appendicectomy 30%, right-sided hemicolectomy 14.6% (open 11.6% and laparoscopic 3%, acute operation 5.5%), ileocaecal resection 5% (acute operation 3.4%), and staging laparoscopy 7%. In 38% of the operated patients the tumour was discovered incidentally at histopathology examination. Two patients had CRS and HIPEC as the initial operation. Forthy-three per cent of the 146 tumour patients operated underwent a second procedure: CRS and HIPEC in 23.3% and right-sided hemicolectomy in 13.6% (laparoscopic 8.2% open 5.4%).
CONCLUSIONS: Survival was high for patients with incidentally detected appendiceal LAMN or NET, but not so for carcinoma. Survival was lower in the carcinoma group older than 50 years, especially those sick and females.
摘要：
目的：探讨因良性阑尾炎而在阑尾切除术中偶然发现的阑尾肿瘤的长期预后。
方法：进行了一项回顾性注册单中心队列研究，使用来自外科手术病例的局部急性阑尾切除术质量登记册的数据，南方总医院,斯德哥尔摩,瑞典。局部结直肠癌登记也用于鉴定阑尾肿瘤。研究期间为2004年1月至2023年1月。根据Kaplan-Meier方法计算存活率。
结果：共有11,888例患者登记在急性阑尾切除术登记处，54%的男性和46%的女性，中位年龄32岁(Q1=21,Q3=47)(33.7%为41岁或以上).从阑尾切除术和结直肠登记中发现了148例阑尾肿瘤（占总队列的1.2％）；女性占60％，男性占40％，中位年龄56岁（Q1=43，Q3=70）（其中78.4%为41岁或以上）。发现的肿瘤是：低级别阑尾黏液性肿瘤（LAMN，N=64）；神经内分泌肿瘤（NETN=24）；腺癌或其他形式的癌（N=57）；和腺瘤（N=3）。接受LAMN手术的患者的5年总生存率为96.8%,净93.3%和腺癌69.7%。所有肿瘤患者的5年总生存率为85.7%。对于LAMN和NET的年轻患者(<51岁)，几乎所有人都存活到随访结束。癌症组患者的生存率明显低于LAMN和NET组，尤其是51岁或以上的女性。在接受手术的肿瘤患者组中（n=146），主要手术为腹腔镜手术的占47％，开腹手术的占52％。两名患者由于广泛的疾病而未接受手术。在64％的病例中，手术是急性的，而它被延迟和/或计划在34%。大多数手术是腹腔镜阑尾切除术36%，其次是开放性阑尾切除术30%,右半结肠切除术14.6%(开腹11.6%,腹腔镜3%,急性手术5.5%)，回肠切除5%（急性手术3.4%），和分期腹腔镜7%。在38％的手术患者中，肿瘤是在组织病理学检查中偶然发现的。两名患者以CRS和HIPEC作为初始手术。146例接受手术的肿瘤患者中，有3％接受了第二次手术：CRS和HIPEC占23.3％，右侧半结肠切除术占13.6％（腹腔镜8.2％开腹5.4％）。
结论：偶然发现阑尾LAMN或NET的患者生存率较高，但癌症并非如此。50岁以上的癌症组的生存率较低，尤其是那些病人和女性。
方法：进行了一项回顾性注册单中心队列研究，使用来自外科手术病例的局部急性阑尾切除术质量登记册的数据，南方总医院,斯德哥尔摩,瑞典。局部结直肠癌登记也用于鉴定阑尾肿瘤。研究期间为2004年1月至2023年1月。根据Kaplan-Meier方法计算存活率。
结果：共有11,888例患者登记在急性阑尾切除术登记处，54%的男性和46%的女性，中位年龄32岁(Q1=21,Q3=47)(33.7%为41岁或以上).从阑尾切除术和结直肠登记中发现了148例阑尾肿瘤（占总队列的1.2％）；女性占60％，男性占40％，中位年龄56岁（Q1=43，Q3=70）（其中78.4%为41岁或以上）。发现的肿瘤是：低级别阑尾黏液性肿瘤（LAMN，N=64）；神经内分泌肿瘤（NETN=24）；腺癌或其他形式的癌（N=57）；和腺瘤（N=3）。接受LAMN手术的患者的5年总生存率为96.8%,净93.3%和腺癌69.7%。所有肿瘤患者的5年总生存率为85.7%。对于LAMN和NET的年轻患者(<51岁)，几乎所有人都存活到随访结束。癌症组患者的生存率明显低于LAMN和NET组，尤其是51岁或以上的女性。在接受手术的肿瘤患者组中（n=146），主要手术为腹腔镜手术的占47％，开腹手术的占52％。两名患者由于广泛的疾病而未接受手术。在64％的病例中，手术是急性的，而它被延迟和/或计划在34%。大多数手术是腹腔镜阑尾切除术36%，其次是开放性阑尾切除术30%,右半结肠切除术14.6%(开腹11.6%,腹腔镜3%,急性手术5.5%)，回肠切除5%（急性手术3.4%），和分期腹腔镜7%。在38％的手术患者中，肿瘤是在组织病理学检查中偶然发现的。两名患者以CRS和HIPEC作为初始手术。146例接受手术的肿瘤患者中，有3％接受了第二次手术：CRS和HIPEC占23.3％，右侧半结肠切除术占13.6％（腹腔镜8.2％开腹5.4％）。
结论：偶然发现阑尾LAMN或NET的患者生存率较高，但癌症并非如此。50岁以上的癌症组的生存率较低，尤其是那些病人和女性。
