Removal of Ovarian Tumors Should Be Accompanied by Appendectomy

A new study indicates that appendectomy may be needed along with oophorectomy for women undergoing surgery for suspected ovarian neoplasm.

Researchers at the University of Virginia Health System (UVHS, Charlottesville, USA) conducted a retrospective analysis of 191 patients who underwent oophorectomy and appendectomy during the same surgical procedures at the UVHS between 1992 to 2007, to investigate the prevalence of appendiceal pathology in women undergoing surgery for a suspected ovarian neoplasm, and the predictive value of intraoperative findings to determine the need for concurrent appendectomy. Observations were stratified based on the nature (benign, borderline, or malignant) and histology (serous compared with mucinous) of the ovarian neoplasm, frozen compared with final pathological diagnosis, and the gross appearance of the appendix.

The results showed that the high rates of coexisting appendiceal pathology were associated with serous ovarian cancers. This involved 94.4% of grossly abnormal and 35.3% of normal appendices. The same was true of ovarian tumors suspected to be of primary gastrointestinal origin, with 82.8% of grossly abnormal and 60% of normal appendices harboring coexisting mucinous neoplasms. Based on linear regression analysis, the researchers recommended appendectomy when frozen section diagnosis is mucinous or serous ovarian carcinoma, borderline tumor, or metastatic carcinoma of suspected gastrointestinal origin. The study was published in the December 2010 issue of Obstetrics and Gynecology.

"Ovarian cancers frequently spread to the appendix, and conversely small or even microscopic appendiceal tumors can metastasize to the ovaries and present as an ovarian mass,” said lead author Amir Jazaeri, MD. "There are situations where appendectomy is prudent even when the appendix looks completely normal because of risk of microscopic abnormalities. These situations include when the frozen section pathology of the ovarian mass reveals serous or mucinous cancers or so-called borderline -- low malignant potential -- ovarian tumors.”

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