Laparoscopy-assisted Partial Cecum Resection Versus Ileocecal Resection for Non-malignant Appendiceal Neoplasms

Preoperative pathological diagnosis of appendiceal tumors is difficult due to their anatomical nature. Although lymph node metastasis is rare in low-grade appendiceal mucinous neoplasms (LAMN), there is a risk of a positive surgical margin by appendectomy. Partial cecum resection is considered an option to obtain negative resection margins for LAMN; however, the benefits of this procedure via a laparoscopic approach remain unclear.

We retrospectively analyzed patients who underwent laparoscopy-assisted partial cecum resection (Lap-Ce) or ileocecum resection (Lap-ICR) for primary appendiceal tumors at our department. An intraoperative pathological diagnosis was requested at the surgeon's discretion. Clinicopathological factors and surgical outcomes were compared among the two groups.

Intraoperative pathological consultations were conducted for 86% (12 of 14 patients) of the Lap-Ce group and 4% (1 of 27 patients) of the Lap-ICR group. Fewer trocars (median: 3) were used in the Lap-Ce group than in the Lap-ICR group (5 trocars in all patients, p<0.0001). The Lap-Ce group had a shorter operative time (median: 113 vs. 197 min, p<0.0001), less blood loss (median: 1 vs. 32 ml, p<0.0001), and a shorter time to the first bowel movement than the Lap-ICR group (2 vs. 3 days, p=0.049). There was no recurrence in either group.

Lap-Ce was less invasive than Lap-ICR as assessed by perioperative variables. Therefore, Lap-Ce is considered to be useful as a primary surgical procedure for clinically benign lesions.