STUDY ON INCIDENCE AND MANAGEMENT OF APPENDICULAR MALIGNANCY IN PATIENTS UNDERGOING APPENDICECTOMY IN A TERTIARY CARE HOSPITAL

Abstract

AIMS: To study the incidence and management of appendicular malignancy in patients undergoing appendicectomy in a tertiary care hospital METHODS: A retrospective study including 1,275 patients who were admitted in JSS hospital, under surgery department, between September 2016 to September 2021. Patients were ≥ 16 years, any gender who presented with pain abdomen, abdominal distension, fever, vomiting, or mass per abdomen, diagnosed as appendicitis or appendicular mass. Patients underwent laparoscopic/open appendicectomy or right hemicolectomy, based on intraoperative ndings. The specimen was sent for histopathological examination and followed up for further management if required. RESULTS: Among 1275 patients who underwent appendicectomy either open or laparoscopy, following histopathological examination of all the appendicectomy specimens, appendicular malignancy was reported in 7 patients (0.53). All 7 patients had complaints of pain in the right iliac fossa. On examination, 71.4% had tenderness in the right iliac fossa. Most common preoperative provisional diagnosis was acute appendicitis (57.1%). 3 patients underwent laparoscopic appendicectomy, 1 open appendicectomy, and based on intraoperative ndings, 2 underwent right hemicolectomy, 1 resection and anastomosis with ileostomy as metastasis was present. Histopathologically, 2 patients were diagnosed with adenocarcinoma appendix, 2 with low grade appendiceal mucinous neoplasm, 2 with metastatic mucinous adenocarcinoma and 1 patient with neuroendocrine tumour of appendix CONCLUSION: Appendiceal tumors are uncommon, majority are comprised of epithelial neoplasms. Present with abdominal pain, manifest as acute appendicitis, or incidentally discovered in appendectomy specimens during histopathological evaluation. Imaging ndings are suggestive of acute appendicitis mostly. CT is used for staging of appendiceal tumors and subsequent follow up. In majority, appendicectomy will be sufcient, and some require right hemicolectomy. Cytoreductive surgery and intraperitoneal chemotherapy have improved the prognosis of patients with peritoneal disease.