Surgical outcomes of appendiceal mucinous neoplasms: A systematic review and meta-analysis.
Phuong Minh Tang, Bui Thien Nghiep Vo, El-Wui Loh et al.
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In 30 seconds
This systematic review and meta-analysis assessed surgical outcomes for appendiceal mucinous neoplasms, drawing on 43 observational cohort studies involving 12,014 patients. For localized disease, recurrence was 1.4% after appendectomy and 2.3% after right hemicolectomy. Among patients with pseudomyxoma peritonei treated with cytoreductive surgery and HIPEC, five-year overall survival varied by histology: 94.2% for acellular mucin, 78.1% for low-grade disease, and 47.4% for high-grade disease. High-grade histology and incomplete cytoreduction were associated with worse survival; the authors caution that certainty is low or very low.
Key findings
- Localized disease recurrence was 1.4% after appendectomy and 2.3% after right hemicolectomy.
- After CRS + HIPEC, five-year overall survival was 94.2%, 78.1%, and 47.4% for acellular mucin, low-grade, and high-grade cohorts, respectively.
- High-grade disease was associated with worse overall survival (HR, 3.19; 95% CI, 1.88-5.41) and disease-free survival (HR, 3.06; 95% CI, 1.68-5.58).
- Incomplete cytoreduction was associated with worse overall survival (HR, 3.39; 95% CI, 1.54-7.45).
Why it matters
The findings show that outcomes differ substantially by histologic grade and completeness of cytoreduction, while recurrence after resection of localized disease was low in the pooled cohorts. These estimates can help frame discussions of prognosis and follow-up, but the evidence base is observational and the review rates certainty as low or very low, limiting confidence in comparisons between surgical approaches.
What to keep in mind
All 43 included studies were observational cohorts; the authors report low or very low certainty, limiting confidence in pooled estimates and comparisons between surgical approaches.