Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, PR China.
Shandong University School of Medicine, Ji'nan, Shandong 250012, PR China.
Gynecol Oncol. 2017 Jan;144(1):215-222. doi: 10.1016/j.ygyno.2016.10.041. Epub 2016 Nov 24.
To evaluate whether routine appendectomy is necessary in all patients with mucinous borderline ovarian tumor (mBOT) or mucinous ovarian cancer (MOC) who undergo gynecologic surgery.
The database of Qilu Hospital was searched for women who underwent appendectomy in a primary surgery for an ovarian tumor between June 2005 and June 2015 and whose final diagnosis was mBOT, MOC or primary appendiceal tumor. A retrospective review was performed, as well as a meta-analysis of the literature to further validate the findings.
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).
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.
评估在妇科手术中对患有黏液性交界性卵巢肿瘤（mBOT）或黏液性卵巢癌（MOC）的所有患者是否有必要进行常规阑尾切除术。
检索 2005 年 6 月至 2015 年 6 月齐鲁医院数据库中接受卵巢肿瘤初次手术时行阑尾切除术的患者，其最终诊断为 mBOT、MOC 或原发性阑尾肿瘤。进行回顾性分析，同时对文献进行荟萃分析以进一步验证结果。
71 例患者，29 例为 mBOT，42 例为恶性黏液性肿瘤（包括 40 例原发性 MOC 和 2 例阑尾黏液性腺癌），在初次手术时行阑尾切除术。在 mBOT 患者中，有 2 例（6.9%）阑尾大体异常，病理诊断为 mBOT 种植性阑尾。在 42 例恶性疾病患者中，有 5 例（12%）阑尾外观大体异常，1 例（2.4%）诊断为 MOC 阑尾转移，2 例（4.7%）为原发性阑尾腺癌。对于大体正常的阑尾，只有 1 例（2.4%）被证实有 MOC 的镜下转移。荟萃分析共纳入 914 例 mBOT 和 MOC 阑尾切除术患者，包括我们目前的病例。阑尾病理总发生率估计为 4.97%，汇总优势比（OR）显示 MOC 和 mBOT 之间有统计学差异（MOC 比 mBOT，OR=2.15，P<0.05）。大体正常与异常阑尾的恶性病理发生率分别为 1.4%和 59%，估计 OR 高达 97.5（95%CI 28.1-338.5，P<0.05）。
目前没有足够的证据支持对 mBOT 和 MOC 中大体正常的阑尾患者进行常规阑尾切除术。术中仔细探查阑尾至关重要，但只有当阑尾异常时才需要行阑尾切除术。
