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Clinical Significance of Lymph Node Dissection and Lymph Node Metastasis in Primary Appendiceal Tumor Patients After Curative Resection: a Retrospective Multicenter Cohort Study

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Purpose

Due to its rarity and biological heterogeneity, guidelines for primary appendiceal tumor (PAT) are based on scarce evidence, resulting in no strong recommendations. The present study explored prognosis-related factors, including the timing of lymph node dissection (LND), in PAT patients after curative resection (CR) to determine the optimal surgical therapies.

Methods

We retrospectively collected and analyzed data from 404 patients with PATs who underwent CR at 43 tertiary hospitals from 2000 to 2017. This manuscript is based on revised manuscript during review process. Please, change the bold characters to normal characters in the manuscript.

Results

After propensity score matching, there were no marked differences in the recurrence-free survival (RFS) or overall survival (OS) between the primary and secondary LND groups (P = 0.993 and 0.728). A multivariate analysis showed that lymph node metastasis (LNM) was an independent factor for the RFS (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.09–6.13; P = 0.031) and OS (HR 4.70; 95% CI 1.40–15.76; P = 0.012). There were significant associations between the LNM rates and tumor depth (P < 0.0001) and the histological type (P = 0.006). There was no LNM in patients with low-grade appendiceal mucinous neoplasm (LAMN) or well-differentiated mucinous adenocarcinoma (G1) or patients with any Tis or T1 PATs.

Conclusions

LNM was an independent prognostic predictor in PATs after CR with LND. Tumor depth and histological type were not prognostic predictors but were LNM predictors. Secondary LND based on the pathological findings of resected specimens is considered an acceptable surgical management without a worse prognosis than primary LND, and it may be omitted in LAMN+G1 or in any Tis and T1 PATs.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding authors on reasonable request, but no information infringing on the privacy of the participants will be given.

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Acknowledgements

The following doctors cooperated in this study: M. Ikeda (Hyogo College of Medicine), M. Itabashi (Tokyo Women’s Medical University), Y. Ide (Yao Municipal Hospital), M. Ito (National Cancer Center Hospital East), A. Iwashita (Fukuoka University Chikushi Hospital), S. Okamura (Suita Municipal Hospital), E. Oki (Kyushu University), H. Ozawa (Tochigi Cancer Center), T. Kato (Osaka National Hospital), Y. Kanemitsu (National Cancer Center Hospital), M. Shiozawa (Kanagawa Cancer Center), T. Shioda (Kobe City Nishi-Kobe Medical Center), A. Shiomi (Shizuoka Cancer Center Hospital), I. Takemasa (Sapproro Medical University), H. Taniguchi (Aichi Cancer Center Hospital), M. Nakanishi (Kyoto Prefectural University of Medicine), T. Furuhata (St. Marianna Medical University Toyoko Hospital), S. Morita (Toyonaka Municipal Hospital), M. Yasui (Osaka International Cancer Institute), K. Yamazaki (Shizuoka Cancer Center Hospital), H. Yokomizo (Tokyo Women’s Medical University Medical Center East), K. Yoshimatsu (Saiseikai Kurihashi Hospital), T. Komori (Osaka General Medical Center), M. Tsujie (Sakai City Medical Center), H. Ohta (Ikeda City Hospital), M. Ikenaga (Higashiosaka City Medical Center), H. Mizuno (Nippon Life Hospital), A. Ogawa (Tane General Hospital), K. Yasumasa (Japan Community Health care Organization Osaka Hospital), K. Tamagawa (Otemae Hospital), H. Takemoto (Kinki Central Hospital), T. Shingai (Saiseikai Senri Hospital), Y. Suzuki (Osaka Police Hospital), M. Fukunaga (Hyogo Prefectural Nishinomiya Hospital), Y. Fukunaga (Cancer Institute Hospital), Y. Ohno (Osaka University), T. Mizushima (Osaka University), and Y. Doki (Osaka University).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Minoh City Hospital, Minoh, Japan

    Hiroshi Takeyama

  2. Department of Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan

    Hiroshi Takeyama & Shingo Noura

  3. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan

    Kohei Murata & Yoshinori Kagawa

  4. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan

    Takashi Takeda

  5. Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan

    Makoto Fujii

  6. StemRIM Institute of Regeneration-Inducing Medicine, Division of Health Science, Osaka University Graduate School of Medicine, Suita, Japan

    Makoto Fujii

  7. Department of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Hiroshi Kawachi

  8. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Tatsuro Yamaguchi

  9. Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan

    Toshiki Masuishi

  10. Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan

    Akira Inoue

  11. Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan

    Yasumasa Takii

  12. Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan

    Takeshi Suto

  13. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan

    Kazuhiro Sakamoto

  14. Department of Surgery, Osaka Rosai Hospital, Sakai, Japan

    Mitsuyoshi Tei

  15. Department of Surgical Pathology, Kyoto City Hospital, Kyoto, Japan

    Mitsuo Kishimoto

  16. Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Takashi Yao

  17. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Hiroshi Takeyama
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  2. Kohei Murata
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  3. Takashi Takeda
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  4. Makoto Fujii
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  5. Yoshinori Kagawa
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  8. Shingo Noura
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  14. Mitsuyoshi Tei
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  15. Mitsuo Kishimoto
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  16. Takashi Yao
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  17. Kenichi Sugihara
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Consortia

on behalf of the study group of appendiceal neoplasms in Japan Society of Colorectal Cancer Research Group

Corresponding author

Correspondence to Hiroshi Takeyama.

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Takeyama, H., Murata, K., Takeda, T. et al. Clinical Significance of Lymph Node Dissection and Lymph Node Metastasis in Primary Appendiceal Tumor Patients After Curative Resection: a Retrospective Multicenter Cohort Study. J Gastrointest Surg 26, 128–140 (2022). https://doi.org/10.1007/s11605-021-05070-6

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  • DOI: https://doi.org/10.1007/s11605-021-05070-6

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