The management of mucinous appendiceal lesions: Case series and review of the literature

Abstract

Objective: The management strategy of mucinous appendiceal tumors in the context of our clinical experiences was discussed. Design: Retrospective study Settings: Department of General Surgery and Surgical Oncology, Gaziosmanpasa University Hospital, Turkey Subjects: Our registries were reviewed to retrieve cases of mucinous appendiceal tumors treated in our hospital between March 2010 and November 2018. Interventions: None Main outcome measure: The role of minimally invasive surgery in the management of appendiceal mucinous lesions. Results: Eleven cases, six males and five females, with a median age of 65.3 years were included. Laparoscopic appendectomy was performed in seven cases of low grade appendiceal mucinous neoplasm (LAMN), all of which did not require further surgery, except for one patient whose definitive histopathological result showed LAMN with the entrapment of the base of the appendix and a recurrent mass in the 5th month postoperatively requesting further surgery (laparoscopic right hemicolectomy). One case of LAMN with entanglement of the base of the appendix necessitated a partial typhlectomy (partial cecectomy), and three cases of large mucocele with high malignancy suspicion were treated with laparoscopic right hemicolectomy the definitive; pathologic reports showed LAMN in two cases and mucinous adenocarcinoma in one. Conclusion: In elderly patients, right lower quadrant pain should be attentively approached and one should keep in mind mucocele lesions of the appendix. Careful history-taking, physical examination and necessary radiological imaging will help the diagnosis preoperatively. Mucinous appendiceal lesions should be rather managed under elective circumstances where the need of frozen section examination may be required. Laparoscopic approach is appropriate in experienced hands.