Safa TOPRAK, Recep Erçin SÖNMEZ, Melek BÜYÜK, Mehmet İLHAN, Ali Fuat Kaan GÖK, Mine GÜLLÜOĞLU, Cemalettin ERTEKİN, Mustafa Kayıhan GÜNAY

APENDİKS TÜMÖRLERİNİN CERRAHİ TEDAVİSİ: 15 YILLIK TEK MERKEZLİ BİR İNCELEME

Amaç: Apendiksin primer neoplazmları, çoğu klinisyenin aşina olmadığı nadir bir durumdur. Seçilen yaklaşım apendektomiden sitoredüktif cerrahiye farklılık gösterebilir. Apendiks tümörlerinin cerrahi tedavisi ile ilgili klinik deneyimimizi sunmayı amaçladık.Gereç ve Yöntem: Ocak 2006 ile Şubat 2021 arasında; apendektomi öyküsü olan 4450 hasta geriye dönük olarak incelendi. ‘Tırtıklı lezyon/polip, düşük/yüksek dereceli apendiks müsinöz neoplazm (LAMN/HAMN), müsinöz/müsinöz olmayan/goblet hücreli adenokarsinom, nöroendokrin tümör (NET)’ tanısı alan hastalar çalışmaya dahil edildi. Histolojik değerlendirmeler, cerrahi prosedürler, takip verileri ve sağkalım sonuçları değerlendirildi.Bulgular: Apendiks tümörü tanısı konan 132 [K:87 (%65.9)] hastadan; 27’si (%20,5) benign (Grup A), 61’i (%46,2) borderline (Grup B) ve 44’ü (%33,3) malign (Grup C) grupta idi. Primer operasyon olarak sırasıyla 105 (%79,5) ve 27 (%20,5) hastaya apendektomi ve sağ hemikolektomi uygulandı. Daha önce apendektomi öyküsü olan 17 hastaya (%12.9) sağ hemikolektomi (n=9; cerrahi sınır pozitifliği nedeniyle) ve Hipertermik İntraperitoneal Kemoterapi (HIPEC) ile Sitoredüktif Cerrahi (CRS) (n=8; nüks nedeniyle) sekonder cerrahi olarak uygulandı. Takip süresi boyunca 88 (%66,6) hastaya sadece apendektomi uygulandı. Adenokarsinom, nükssüz sağkalım (RFS) için istatistiksel olarak anlamlı bir faktör olarak ortaya çıktı (HR=7.28, p=0.049). Malignite (HR=3.76, p=0.036) ve yaş (≥60) (HR=3.86, p=0.006) genel sağkalımın (OS) önemli faktörleriydi.Sonuç: Apendektomi, işlemin düşük morbiditesi ve olumlu sağkalım sonuçları göz önüne alındığında, seçilmiş vakalarda apendiks tümörlerinin tedavisinde etkilidir. İleri evre tümörler için kemoterapi ile birlikte genişletilmiş rezeksiyonlar tercih edilen yaklaşım olmalıdır.

Anahtar Kelimeler:

Apendiks tümörleri, Hipertermik intraperitoneal kemoterapi (HIPEC), nöroendokrin tümör, düşük dereceli apendiküler müsinöz neoplazi, tırtıklı lezyon, apendektomi

SURGICAL MANAGEMENT OF APPENDIX TUMORS: A SINGLE-CENTER REVIEW OF 15 YEARS

Objective: Primary neoplasms of the appendix are rare and most clinicians are unfamiliar with them. The selected approach may differ, ranging from appendectomy to cytoreductive surgery. We aimed to present our clinical experience with the surgical management of appendix tumors.Materials and Methods: 4,450 patients with a history of appendectomy from January 2006 to February 2021 were analyzed retrospectively. Patients diagnosed with “serrated lesion/polyp, low/high-grade appendiceal mucinous neoplasm (LAMN/ HAMN), mucinous/non-mucinous/goblet cell adenocarcinoma, neuroendocrine tumor (NET)” were included in the study. Histological evaluations, surgical procedures, follow-up data, and survival outcomes were evaluated.Results: Among 132 [F:87 (65.9%)] patients diagnosed with appendix tumors, 27 (20.5%) were in the benign group (Group A), 61 (46.2%) were in the borderline group (Group B), and 44 (33.3%) were in the malignant group (Group C). Appendectomy and right hemicolectomy were performed as the initial operations in 105 (79.5%) and 27 (20.5%) patients, respectively. Seventeen patients (12.9%) with a previous history of appendectomy received right hemicolectomy (n=9; due to surgical margin positivity) and Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) (n=8; due to recurrence) as redo surgery during the follow-up period. Appendectomy was sufficient for 88 (66.6%) patients. Adenocarcinoma was revealed as a statistically significant factor for recurrence-free survival (RFS) (HR=7.28, p=0.049). Malignancy (HR=3.76, p=0.036) and age (≥60) (HR=3.86, p=0.006) were significant factors of overall survival (OS). Conclusion: Appendectomy is efficient in the treatment of appendix tumors for selected cases considering low morbidity of the procedure and favorable survival outcomes. For advanced-stage tumors, extended resections combined with chemotherapy should be the preferred approach.

Keywords:

Appendix tumors, Hyperthermic intraperitoneal chemotherapy (HIPEC), neuroendocrine tumor, low-grade appendicular mucinous neoplasia, serrated lesion, appendectomy,

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