Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
Department of Gastroenterological Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
Surg Endosc. 2021 Oct;35(10):5515-5523. doi: 10.1007/s00464-020-08046-w. Epub 2020 Sep 29.
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.
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.
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].
Laparoscopic surgery is comparable to open surgery and can be considered a treatment option for primary appendiceal tumors.
由于原发性阑尾肿瘤较为罕见，目前尚未证明腹腔镜手术治疗原发性阑尾肿瘤的可行性优于开放手术。本研究旨在比较腹腔镜和开放手术治疗原发性阑尾肿瘤的长期疗效。
在这项多中心回顾性队列研究中，分析了日本 43 家三级医院 2000 年至 2017 年间经组织学诊断为原发性阑尾肿瘤的患者数据。共评估了 922 例患者，其中 679 例符合分析条件。通过倾向评分，对 114 例开放手术病例和 114 例腹腔镜手术病例的基线特征进行了匹配。主要终点为无复发生存（不包括伴有远处转移的 IV 期疾病患者）和总生存。
腹腔镜转为开放手术的比例为 1.5%。腹腔镜组和开放手术组的 5 年无复发生存率分别为 80.4%（95%置信区间：71.0-89.7）和 78.2%（95%置信区间：69.0-87.3），差异无统计学意义（p=0.57）。腹腔镜组和开放手术组的 5 年总生存率分别为 83.5%（95%置信区间：74.4-92.7）和 72.7%（95%置信区间：62.3-83.0），差异无统计学意义（p=0.09）。多因素分析显示，腹腔镜手术不是总生存的独立预后因素[风险比：0.49（95%置信区间：0.23-1.06），p=0.0707]。
腹腔镜手术与开放手术相当，可作为原发性阑尾肿瘤的治疗选择。
