Appendectomy with cytoreductive surgery for ovarian and type 2 endometrial carcinoma

There is considerable variation within and between cancer centers in the practice of appendectomy as part of cytoreductive surgery for ovarian carcinoma and in the surgical staging of endometrial carcinoma. The purpose of this study was to determine the prevalence and the type of appendiceal pathology, the morbidity associated with appendectomy in gynaecologic cancer surgery. Materials and Methods: This is a retrospective review of all cytoreductive surgery for ovarian carcinoma and surgical staging for endometrial carcinoma with appendectomy over a four year period. Results: Two hundred and fifty-one patients (38 patients for endometrial carcinoma surgery and 213 patients for ovarian cytoreduction) had an appendectomy performed. Metastases to the appendix was present in 46 (23.2%) of primary ovarian carcinoma and one (2.6%) primary endometrial carcinosarcoma. The appendix was more likely to be involved in advanced stage ovarian cancer with positive peritoneal washings, omental deposits, grade 3 differentiation, and papillary serous histology. Sixteen (6.4%) co-incidental primary appendiceal tumours were detected. No postoperative morbidity specific to appendectomy was identified. One case of ovarian carcinoma was upstaged from IC to IIIA by the appendiceal metastases. There was no upstaging of disease in the endometrial carcinoma group. Discussion: Appendectomy is an integral part of ovarian cytoreductive surgery but the authors found it did not upstage the disease in a clinically significant manner. The incidence of co-incidental appendiceal primary tumours was high in this series and may add value to the procedure in preventing further surgeries. The absence of procedure related morbidity is reassuring. The authors recommend appendectomy for all ovarian staging surgery and its consideration in type 2 endometrial cancer.

Cytoreductive surgery; Ovarian cancer; Endometrial cancer; Appendectomy; Gynaecological malignancy; Staging; Appendiceal tumours.

[1] Cibula D., Verheijen R., Lopes A., Dusek L.: “ESGO Council. Current clinical practice in cytoreductive surgery for advanced ovarian cancer: a European survey”. Int. J. Gynecol. Cancer, 2011, 21, 1219.

[2] Fontanelli R., Paladini D., Raspagliesi F., di Re E.: “The role of appendectomy in surgical procedures for ovarian cancer”. Gynecol. Oncol., 1992, 46, 42.

[3] Rose P.G., Reale F.R., Fisher A., Hunter R.E.: “Appendectomy in primary and secondary staging operations for ovarian malignancy”. Obstet. Gynecol., 1991, 77, 116.

[4] Marino B.D., Burke T.W., Tornos C., Chuang L., Mitchell M.F., Tortolero-Luna G., et al.: “Staging laparotomy for endometrial carcinoma: assessment of peritoneal spread”. Gynecol. Oncol., 1995, 56, 34.

[5] Dilek S., Dilek U., Dede M., Deveci M.S., Yenen M.C.: “The role of omentectomy and appendectomy during the surgical staging of clinical stage I endometrial cancer”. Int. J. Gynecol. Cancer, 2006, 16, 795.

[6] Ayhan A., Gultekin M., Taskiran C., Salman M.C., Celik N.Y., Yuce K., et al.: “Routine appendectomy in epithelial ovarian carcinoma: is it necessary?” Obstet. Gynecol., 2005, 105, 719.

[7] Jie L., Oluwole F., Li X., Kong B., Zheng W.: “Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis”. J. Hematol. Oncol., 2012, 5, 8.

[8] Ramirez P.T., Slomovitz B.M., McQuinn L., Levenback C., Coleman R. L.: “Role of appendectomy at the time of primary surgery in patients with early-stage ovarian cancer”. Gynecol. Oncol., 2006, 103, 888.

[9] Beşe T., Kösebay D., Kaleli S., Oz A.U., Demirkiran F., Gezer A.: “Appendectomy in the surgical staging of ovarian carcinoma”. Int. J. Gynaecol. Obstet., 1996, 53, 249.

[10] Prayson R.A., Hart W.R., Petras R.E.: “Pseudomyxoma peritonei. A clinicopathologic study of 19 cases with emphasis on site of origin and nature of associated ovarian tumors”. Am. J. Surg. Pathol., 1994, 18, 591.

[11] Timofeev J., Galgano M.T., Stoler M.H., Lachance J.A., Modesitt S. C., Jazaeri A.A.: “Appendiceal pathology at the time of oophorectomy for ovarian neoplasms”. Obstet. Gynecol., 2010, 116, 1348.

[12] Dietrich C.S., Desimone C.P., Modesitt S.C., Depriest P.D., Ueland F. R., Pavlik E.J., et al.: “Primary appendiceal cancer: gynaecologic manifestations and treatment options”. Gynecol. Oncol., 2007, 104, 602.

[13] Collins D.C.: “71,000 human appendix specimens. A final report summarizing forty years’ study”. Am. J. Proctol., 1963, 14, 365.

[14] Hristov A.C., Young R.H., Vang R., Yemelyanova A.V., Seidman J. D., Ronnett B.M.: “Ovarian metastases of appendiceal tumours with goblet cell carcinoid like and signet ring cell patterns: a report of 30 cases”. Am. J. Surg. Pathol., 2007, 31, 1502.

[15] Bucher P., Gervaz P., Ris F., Oulhaci W., Egger J.F., Morel P.: “Surgical treatment of appendiceal adenocarcinoid (goblet cell carcinoid)”. World J. Surg., 2005, 29, 1436.

[16] Saygili U., Kavaz S., Altunyurt S., Uslu T., Koyuncuoglu M., Erten O.: “Omentectomy, peritoneal biopsy and appendectomy in patients with clinical stage I endometrial carcinoma”. Int. J. Gynecol. Cancer, 2001, 11, 471.