Analysis Of Clinical Features Of Single-center Appendiceal Tumor

Objective:To analyze the real data of appendiceal tumor patients in our center,so as to provide a theoretical basis for improving the preoperative diagnosis rate and reducing the probability of secondary surgery.Methods:Various clinical data of patients with pathologically confirmed appendiceal tumors from January 2016 to December 2022 in the medical record system of the Second Affiliated Hospital of Guangzhou Medical University were checked,and 43 patients with complete data were collected finally.In general,the detail clinical data include the age,gender,main symptoms,disease duration,blood routine,serum oncological indexes,preoperative examination(consist of CT,ultrasound,and colonoscopy),operative methods,intraoperative cryopathology and postoperative pathological results.Meanwhile 43 patients were followed up by recording the follow-up time,presence of recurrence,survival time of deceased patients and causes of death.The data were tested by S-W test with SPSS 25.0 and described using the mean ± standard deviation for continuous normally distributed data and the median for skewed distributed data.Kaplan-Meier survival curves were plotted using Graph Prism,and Log-Rank analysis was performed to analyze the effect of single factor on survival.Results:A total of 43 cases of primary appendiceal tumors(1.9%)were included in this study which were obtained from 2215 appendiceal specimens collected during the same period in the pathology department.Among them,21(48.8%)were male and 22(51.2%)were female,with a male-to-female ratio of 1:1.05.The age range was 34-79 years,with a mean age of 59.6 ± 12.8 years.What’s more,2 patients(4.7%)younger than 40 years,21 patients(48.8%)between 40 and 60 years,and 20 patients older than 60 years.The clinical manifestations of patients suffering appendiceal tumors were mainly as follows: typical acute appendicitis with metastatic right lower abdominal pain manifested in 8 cases(18.7%),chronic right lower abdominal pain in 20 cases(46.5%),and no specific symptoms such as simple abdominal distension,vague pain around the umbilicus,blood in the stool,intestinal obstruction,inaccurate localization of abdominal pain and asymptomatic in 15 cases(34.8%).The duration of disease onset was less than 1 week in 16 patients(37.2%),between 1 week to 1 month in 5(11.6%),more than 1 month in 22(51.2%).Also,13 patients(30.2%)admitted by the emergency route and 30 patients(69.8%)admitted as outpatients.Among them,10 patients(25%)had elevated CEA,6 patients(15%)had elevated CA125,2 patients(5%)had elevated CA19-9,and 3 patients(7.5%)had elevated CA72-4.Appendiceal tumor diagnosis: 12 patients(27.9%)relied on CT characteristic manifestations to establish the preoperative diagnosis,2 patients(4.7%)relied on colonoscopy and 16 patients(37.2%)relied on intraoperative diagnosis.13 patients(30.2%)were misdiagnosed:there were 8 cases(18.5%)of misdiagnosis of appendicitis despite the presence of CT testing,2 cases(4.7%)of misdiagnosis despite the using of ultrasound,1 case(2.3%)of misdiagnosis despite rapid intraoperative freezing was performed,and 2 cases(4.7%)of failure to perform auxiliary examinations.Operative methods: 16 cases(37.2%)of appendectomy,12 cases(27.9%)of ileocolic resection,14 cases(32.6%)of right hemicolectomy,tumor cytoreductive surgery combined with intraperitoneal thermal perfusion chemotherapy in 1 case(2.3%).Pathological types: low-grade appendiceal mucinous tumor in 26 cases(60.4%),high-grade mucinous tumor in 1 case(2.3%),appendiceal mucinous adenocarcinoma in 7 cases(16.2%),appendiceal adenocarcinoma in 3 cases(7.0%),appendiceal goblet cell adenocarcinoma in 2 cases(4.7%),appendiceal neuroendocrine tumor in 2 cases(4.7%),and 2 cases of serrated polyps(4.7%).Among 43 patients,5 patients were lost to follow-up,with a follow-up rate of 88.4%and period of 6-70 months,as well as a median follow-up time of 30 months.Six of the patients died: 2 suffering from low-grade mucinous tumors of the appendix,1 from mucinous carcinoma of the appendix,2 from adenocarcinoma of the appendix,and 1from goblet cell adenocarcinoma of the appendix,with survival times of 30,12,16,27,18,and 29 months,respectively.For malignant tumors(including appendiceal adenocarcinoma,appendiceal mucinous adenocarcinoma,and appendiceal goblet cell adenocarcinoma),survival difference analysis showed no statistical difference between ileal resection and right hemicolectomy(P > 0.05).Conclusion:1.Preoperative diagnosis of appendiceal tumors is difficult,and the combination of patients’ characteristic CT manifestations,tumor markers,and intraoperative rapid freezing can not only improve the correct rate of preoperative and intraoperative diagnosis of appendiceal tumors,but also reduce the incidence of secondary surgery.2.Three types of surgical procedures are selected according to the scope of invasion: simple appendectomy,ileocolic resection,and right hemicolectomy.In the single-center sample,however,there is insufficient evidence for the improvement of survival prognosis of extended resection of appendiceal malignant tumor.