Retrospective Study Of 180 Malignant Mucinous Ovarian Neoplasms And System Meta-Analysis About Routine Appendectomy Issue

Objectives:To discuss the clinical and pathological characteristics of mucinous ovarian cancer(MOC)and evaluate the really incidence of primary mucinous ovarian cancer and metastatic mucinous ovarian cancer.And to evaluate whether routine appendectomy is necessary in all patients with mucinous borderline ovarian tumor(mBOT)or MOC who undergo gynecologic surgery.Materials and Methods:The database of Qilu Hospital was searched for women with ovarian mucinous tumor in a primary surgery for an ovarian tumor between June 2005 and June 2015.In current study,we review all of mucinous ovarian malignant cancer,explore their clinical and pathological characteristics,and immunohistochemistry of CK7,CK20 and CDX2 was performed to help to distinguish the primary mucinous cancer form metastatic mucinous cancer.Those who underwent appendectomy and were diagnosed with mBOT,MOC or primary appendiceal tumor were searched,and a retrospective review was performed,as well as a meta-analysis of the literature to further validate the findings.Result:In the database of Qilu Hospital for decade,the malignant mucinous ovarian tumor,including primary and metastatic mucinous neoplasm,account for 16.1%(180/1103)in ovarian cancer,primary mucinous ovarian cancer account for 36.7%among those who are diagnosed of malignant mucinous ovarian tumor,which account for 8.0%(66/825)in all primary ovarian epithelial cancer.Seventy-one patients,29 with mBOT and 42 with malignant mucinous tumors(including 40 with primary MOC and 2 with appendiceal mucinous adenocarcinoma),underwent appendectomy at the time of primary surgery.Among those with mBOT,two(6.9%)appendices were grossly abnormal and pathologically diagnosed with appendiceal implantation by mBOT.In the 42 patients with malignant disease,five(12%)appendices had a grossly abnormal appearance,one(2.4%)was diagnosed with an appendiceal metastasis from MOC and two(4.7%)were primary appendiceal adenocarcinoma.For grossly normal appendices,only one(2.4%)was confirmed to have microscopic metastasis from MOC.The meta-analysis included a total of 914 mBOT and MOC cases with appendectomies,including our current cases.The estimated rate of overall appendiceal pathology is 4.97%,and the pooled odds ratio(OR)showed statistical differences between MOC and mBOT(MOC vs.mBOT,OR=2.15,P<0.05).The estimated malignant pathology rate in macroscopically normal vs.abnormal appendices is 1.4%and 59%,respectively,with an estimated OR up to 97.5(95%CI 28.1-338.5,P<0.05).Conclusion:The incidence of primary mucinous ovarian cancer is 8.0%in all primary ovarian epithelial cancer,and which are characterized by large tumor,unilateral side,and well differentiated.There is not sufficient evidence to support a routine appendectomy for patients with a grossly normal appendix in mBOT and MOC.A careful intra-operative exploration of the appendix is crucial,but appendectomy is only warranted when the appendix is abnormal.