Appendectomy at Gynecologic Surgery: Feasibility and Outcomes in a High Risk Gynecologic Population—Revealing a High Rate of Incidental Appendiceal Cancer

Abstract

Objective: Appendectomy during gynecologic surgery is not performed routinely by most providers, even in patients with pelvic pain complaints or with gynecologic malignancies. Appendectomy, concordant with cancer debulking, can optimize surgical outcomes, and, in patients with pelvic pain, can help diagnose pathologic etiology for those symptoms. With a lifetime rate of appendicitis of 7%–9%, incidental appendectomy can reduce risk for future complications of appendicitis. Design: A retrospective chart review of all patients operated on from April 2012 to July 2016 was performed. Materials and Methods: Data were abstracted to include: age; body mass index; route and indication for surgery; final pathology; complications; and feasibility. Statistics were calculated, using Excel 2007 and the R Project. Results: Charts for 920 patients were reviewed. Of these, charts for 69 patients were excluded due to extraperitoneal procedures; 110 patients had prior appendectomies. There were no complications. In the remaining charts, there were 14 incidental appendiceal primary cancers, 54 metastatic gynecologic cancers wherein appendectomy contributed to optimal debulking, 15 cases of acute appendicitis, and 8 appendiceal specimens with endometriotic implants. Conclusions: Incidental appendectomy is a safe and feasible procedure for both laparoscopic and open abdominal–pelvic procedures. There was a high rate of incidental primary appendiceal cancers, at 2.97%. There was also a high rate of other pathologies, including metastatic tumors, endometriosis, and appendicitis. Removing the appendix during gynecologic surgery can reduce the risks for present and future gastrointestinal cancer, and appendicitis with rupture, as well as contributing to high-quality surgical care in patients with cancer and pelvic pain. (J GYNECOL SURG 33:145)