Take it or leave it? Incidental appendectomy at time of gynecologic oncology laparotomy

The role of appendectomy in gynecologic oncology surgery has primarily been studied in mucinous ovarian pathologies. We sought to assess the safety and potential benefits of performing incidental appendectomy at time of exploratory laparotomy performed by gynecologic oncologists.

Retrospective chart review of patients undergoing exploratory laparotomy with the gynecologic oncology division. Exclusion criteria included cesarean hysterectomy and reoperation. Patients were matched on BMI, procedure date and type. 513 patients were identified for inclusion: 169 patients underwent appendectomy and 344 patients did not. Demographic and clinical characteristics were abstracted from the electronic medical record. Appendiceal appearance was confirmed via pathology report. Safety outcomes included length of hospital stay and postoperative complications.

The two groups were demographically similar. There was no significant difference in length of hospital stay between the cohorts (6.10 ± 5.34 days vs. 5.87 ± 5.34 days, P = 0.645) and no increased rate of any of the postoperative complications in the appendectomy group. 119 patients (70.4 %) had abnormal appendixes intraoperatively. Among normal appendixes, six (12 %) had an occult finding only diagnosed on final pathology. No patients with apparent pelvic-confined gynecologic cancer were upstaged solely due to metastasis to the appendix.

When performed by a gynecologic oncologist, appendectomy at the time of laparotomy was safe and did not increase the risk of complications. Our results demonstrate a high rate of occult abnormal histology despite a normal intraoperative appearance. These findings suggest that intraoperative appearance alone is not sufficient, and support performing incidental appendectomy at the time of gynecologic oncology exploratory laparotomy.