Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Colorectal Dis. 2017 Oct;19(10):895-906. doi: 10.1111/codi.13746.
The operative treatment for non-metastatic appendiceal carcinoma is controversial despite the recommendation of right hemicolectomy (RH) by many researchers. The aim of this population-based study was to compare outcomes after RH and less radical resection than right hemicolectomy (LRH).
A total of 1144 patients who underwent resection with additional lymphadenectomy of Stages I-III appendiceal carcinoma from 2004 to 2012 were identified in the Surveillance, Epidemiology and End Results database. Overall survival (OS) and cancer-specific survival (CSS) after RH and LRH were assessed by unadjusted and risk-adjusted Cox regression analysis and by propensity score matched analysis.
A total of 855 (74.7%) patients underwent RH and 289 (25.3%) underwent LRH. In an unadjusted analysis, survival after LRH and RH did not differ in OS [hazard ratio (HR) 0.95, 95% CI 0.71-1.26, P = 0.707] and CSS (HR 0.95, 95% CI 0.69-1.32, P = 0.762). The 5-year OS and CSS in patients who underwent RH were 71.6% (95% CI 67.8-75.6%) and 76.4% (95% CI 72.8-80.3) compared with 73.8% (95% CI 67.9-80.2) and 78.7% (95% CI 73.2-84.7) in patients with LRH, respectively. No relevant difference in survival between LRH and RH could be observed in a multivariable analysis (OS, HR 0.90, 95% CI 0.65-1.25, P = 0.493; CSS, HR 0.87, 95% CI 0.60-1.26, P = 0.420) and after propensity score adjusted analysis (OS, HR 0.87, 95% CI 0.62-1.22, P = 0.442; CSS, HR 0.97, 95% CI 0.67-1.40, P = 0.883).
In this retrospective analysis, survival after RH for non-metastatic appendiceal carcinoma was not statistically significantly superior to LRH. Hence, LRH with lymphadenectomy might be sufficient for treatment of non-metastatic appendiceal carcinoma.
尽管许多研究人员建议行右半结肠切除术（RH），但对于非转移性阑尾癌的手术治疗仍存在争议。本基于人群的研究旨在比较 RH 和比右半结肠切除术（LRH）更不激进的切除术后的结果。
在 2004 年至 2012 年间，从监测、流行病学和最终结果数据库中确定了 1144 名接受 I-III 期阑尾癌切除术和附加淋巴结切除术的患者。通过未调整和风险调整的 Cox 回归分析以及倾向评分匹配分析，评估 RH 和 LRH 后的总生存率（OS）和癌症特异性生存率（CSS）。
共有 855 名（74.7%）患者行 RH，289 名（25.3%）患者行 LRH。在未调整的分析中，LRH 和 RH 后的生存情况在 OS 方面没有差异[风险比（HR）0.95，95%CI 0.71-1.26，P=0.707]和 CSS（HR 0.95，95%CI 0.69-1.32，P=0.762）。RH 组的 5 年 OS 和 CSS 分别为 71.6%（95%CI 67.8-75.6%）和 76.4%（95%CI 72.8-80.3%），而 LRH 组分别为 73.8%（95%CI 67.9-80.2%）和 78.7%（95%CI 73.2-84.7%）。多变量分析（OS，HR 0.90，95%CI 0.65-1.25，P=0.493；CSS，HR 0.87，95%CI 0.60-1.26，P=0.420）和倾向评分调整后分析（OS，HR 0.87，95%CI 0.62-1.22，P=0.442；CSS，HR 0.97，95%CI 0.67-1.40，P=0.883）均未显示 RH 和 LRH 之间生存存在差异。
在这项回顾性分析中，RH 治疗非转移性阑尾癌的生存率没有统计学意义上的优势。因此，LRH 联合淋巴结切除术可能足以治疗非转移性阑尾癌。
