Routine appendicectomy be performed as a part of surgical staging in ovarian cancer

Abstract

Background: The role of appendicectomy in epithelial ovarian malignancy is debatable, and therefore to incorporate appendicectomy as a part of surgical staging especially in nonmucinous epithelial types of ovarian cancer is a real subject of controversy. The aim was to determine the incidence of appendiceal involvement in ovarian malignancy and the factors which increase the probability of involvement.

Methods: This was a retrospective study conducted at gynecology department at RGCI and RC, New Delhi. 102 women who had undergone staging laparotomy for ovarian malignancy in whom routine appendectomy was also done between January 2011 and April 2014 were included. Demographic data along with tumor markers and detailed histopathological findings were recorded and statistical analysis using multiple logistic regression curves was done.

Results: Out of 102 women, appendiceal involvement was identified in 52 (50.98%). Patients in whom omentum and lymphnode were positive for metastasis (O.R: 13.7, P: 0.002; O.R: 6.6, P: 0.002; respectively) showed significantly higher chance of involvement of appendix. Though statistically not significant, women having right or bilateral tumors, Ca 125 value >500u/ml and positive peritoneal cytology also had higher chances of appendiceal metastasis.

Conclusions: This study showed that there was higher incidence of appendiceal metastasis in advanced stages (III and IV). Thus appendicectomy can be incorporated routinely in the surgical management (mucinous /non mucinous) even if there is no gross involvement to achieve optimal debulking.