Nononcologic Resection and Survival in High-Risk Appendiceal Cancer: A National Cancer Database Study.

Area of Science:

• Surgical Oncology
• Gastrointestinal Cancer Research
• Clinical Outcomes Analysis

Background:

• Appendiceal adenocarcinoma guidelines recommend oncologic colectomy for high-risk cases.
• Nononcologic resection (NOR), such as appendectomy, is sometimes performed instead.
• This study investigates survival outcomes for high-risk appendiceal cancer patients receiving NOR versus oncologic colectomy.

Purpose of the Study:

• To evaluate the association between nononcologic resection (NOR) and survival in high-risk appendiceal adenocarcinoma.
• To identify patient and disease characteristics associated with NOR in high-risk appendiceal adenocarcinoma.
• To compare survival rates between NOR and oncologic colectomy in this patient cohort.

Main Methods:

• Retrospective analysis of 4510 appendiceal adenocarcinoma patients (2010-2019) from the National Cancer Database.
• Selection of patients with high-risk features (e.g., high grade, advanced stage, positive margins).
• Propensity score matching (1:1) and multivariable logistic regression to compare 5-year survival between NOR and oncologic colectomy groups.

Main Results:

• 37.6% of high-risk patients received NOR.
• NOR was associated with older age, Black race, community centers, early-stage disease, positive margins, and no adjuvant chemotherapy.
• Oncologic colectomy was associated with significantly higher 5-year overall survival compared to NOR (67.5% vs. 60.7%, P < 0.0001) post-matching.

Conclusions:

• Nononcologic resection (NOR) in high-risk appendiceal adenocarcinoma is linked to worse survival outcomes.
• Older patients and those with early-stage disease are disproportionately more likely to undergo NOR.
• Adherence to oncologic colectomy guidelines is crucial for improving survival in high-risk appendiceal cancer.