Open versus laparoscopic surgery for primary appendiceal tumors: a large multicenter retrospective propensity score-matc
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and Other Interventional Techniques
Open versus laparoscopic surgery for primary appendiceal tumors: a large multicenter retrospective propensity score‑matched cohort study in Japan Akira Inoue1 · Kohei Murata2 · Takamichi Komori1 · Takashi Takeda3 · Makoto Fujii4,5 · Tomohiro Yamaguchi6 · Tatsuro Yamaguchi7 · Toshiki Masuishi8 · Tetsuya Shiota9 · Shunji Morita10 · Yozo Suzuki11 · Masaaki Ito12 · Yukihide Kanemitsu13 · Manabu Shiozawa14 · Masayoshi Yasui15 · Yoshinori Kagawa2 · Kenichi Sugihara16 · On behalf of the Study Group of Appendiceal Neoplasms from the Japan Society of Colorectal Cancer Research Group Received: 12 June 2020 / Accepted: 22 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The feasibility of laparoscopic surgery for primary appendiceal tumors compared to that of open surgery has not been demonstrated to date because primary appendiceal tumors are rare. This study aimed to compare the long-term outcomes between laparoscopic and open surgeries for primary appendiceal tumors. Methods In this multicenter retrospective cohort study, the data of patients who had been histologically diagnosed with primary appendiceal tumors at 43 tertiary hospitals in Japan between 2000 and 2017 were analyzed. In total, 922 patients were assessed, and 679 cases were eligible for analysis. Using propensity scores, the baseline characteristics were matched for 114 open surgery cases and 114 laparoscopic surgery cases. The primary endpoints were recurrence-free survival (excluding patients with stage IV disease with distant metastasis) and overall survival. Results The rate of conversion from laparoscopic to open surgery was 1.5%. The 5-year recurrence-free survival rates were 80.4% (95% confidence interval: 71.0–89.7) and 78.2% (95% confidence interval: 69.0–87.3) in the laparoscopic and open surgery groups, respectively, with no significant difference (p = 0.57). No significant difference was observed in the 5-year overall survival rates between the laparoscopic [83.5% (95% confidence interval: 74.4–92.7)] and open surgery [72.7% (95% confidence interval: 62.3–83.0); p = 0.09] groups. In multivariate analysis, laparoscopic surgery was not identified as an independent prognostic factor for overall survival [hazard ratio: 0.49 (95% confidence interval: 0.23–1.06), p = 0.0707]. Conclusions Laparoscopic surgery is comparable to open surgery and can be considered a treatment option for primary appendiceal tumors. Keywords Laparoscopic surgery · Long-term outcomes · Open surgery · Primary appendiceal tumors Primary appendiceal tumors (PATs) are rare, with an incidence rate of 0.9% among all appendectomy specimens [1]. According to the World Health Organization (WHO), PATs comprise several histologic types, broadly characterized as follows: serrated lesions and polyps, mucinous neoplasms, adenocarcinomas, goblet cell adenocarcinomas, and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08046-w) contains
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