Single-incision laparoscopic surgery compared to conventional laparoscopic surgery for appendiceal mucocele: a series of 116 patients

Abstract

Background

Although the safety and feasibility of conventional laparoscopic surgery (CLS) for appendiceal mucocele (AM) has been reported, studies on single-incision laparoscopic surgery (SILS) for AM have not been reported. Here, we aimed to compare the perioperative and short-term outcomes between SILS and CLS for AM and to evaluate the oncological safety of SILS.

Methods

We retrospectively analyzed the medical records of patients, diagnosed based on computed tomography findings, who underwent laparoscopic surgery for AM between 2010 and 2018 at one institution. We excluded patients strongly suspected of having malignant lesions and those with preoperative appendiceal perforation. Patients were divided into two groups—CLS and SILS. Pathological outcomes and long-term results were investigated. The median follow-up period was 43.7 (range: 12.3–118.5) months.

Results

Ultimately, 116 patients (CLS = 68, SILS = 48) were enrolled. Patient demographic characteristics did not differ between the groups. The preoperative mucocele diameter was greater in the CLS than in the SILS group (3.2 ± 2.9 cm vs. 2.3 ± 1.4 cm, P = 0.029). More extensive surgery (right hemicolectomies and ileocecectomies) was performed in the CLS than in the SILS group (P = 0.014). Intraoperative perforation developed in only one patient per group. For appendectomies and cecectomies, the CLS group exhibited a longer operation time than the SILS group (63.3 ± 24.5 min vs. 52.4 ± 17.3 min, P = 0.014); the same was noted for length of postoperative hospital stay (2.9 ± 1.8 days vs. 1.7 ± 0.6 days, P < 0.001). The most common AM etiology was low-grade appendiceal mucinous neoplasm (71/116 [61.2%] patients); none of the patients exhibited mucinous cystadenocarcinoma. Among these 71 patients, there were 8 patients with microscopic appendiceal perforation or positive resection margins. No recurrence was detected.

Conclusions

SILS for AM is feasible and safe perioperatively and in the short-term and yields favorable oncological outcomes. Despite the retrospective nature of the study, SILS may be suitable after careful selection of AM patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Wang H, Chen YQ, Wei R, Wang QB, Song B, Wang CY, Zhang B (2013) Appendiceal mucocele: a diagnostic dilemma in differentiating malignant from benign lesions with CT. AJR Am J Roentgenol 201(4):W590–595

    Article  Google Scholar 

  2. 2.

    Landen S, Bertrand C, Maddern GJ, Herman D, Pourbaix A, de Neve A, Schmitz A (1992) Appendiceal mucoceles and pseudomyxoma peritonei. Surg Gynecol Obstet 175(5):401–404

    CAS  PubMed  Google Scholar 

  3. 3.

    Dhage-Ivatury S, Sugarbaker PH (2006) Update on the surgical approach to mucocele of the appendix. J Am Coll Surg 202(4):680–684

    Article  Google Scholar 

  4. 4.

    Marudanayagam R, Williams GT, Rees BI (2006) Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol 41(8):745–749

    Article  Google Scholar 

  5. 5.

    Marotta B, Chaudhry S, McNaught A, Quereshy F, Vajpeyi R, Chetty R, Ghai S (2019) Predicting Underlying Neoplasms in Appendiceal Mucoceles at CT: Focal Versus Diffuse Luminal Dilatation. AJR Am J Roentgenol 213(2):343–348

    Article  Google Scholar 

  6. 6.

    Stocchi L, Wolff BG, Larson DR, Harrington JR (2003) Surgical treatment of appendiceal mucocele. Arch Surg 138(6):585–589; discussion 589–590

  7. 7.

    Szych C, Staebler A, Connolly DC, Wu R, Cho KR, Ronnett BM (1999) Molecular genetic evidence supporting the clonality and appendiceal origin of Pseudomyxoma peritonei in women. Am J Pathol 154(6):1849–1855

    CAS  Article  Google Scholar 

  8. 8.

    Misdraji J (2010) Appendiceal mucinous neoplasms: controversial issues. Arch Pathol Lab Med 134(6):864–870

    PubMed  Google Scholar 

  9. 9.

    Panarelli NC, Yantiss RK (2011) Mucinous neoplasms of the appendix and peritoneum. Arch Pathol Lab Med 135(10):1261–1268

    Article  Google Scholar 

  10. 10.

    Morano WF, Gleeson EM, Sullivan SH, Padmanaban V, Mapow BL, Shewokis PA, Esquivel J, Bowne WB (2018) Clinicopathological features and management of appendiceal mucoceles: a systematic review. Am Surg 84(2):273–281

    Article  Google Scholar 

  11. 11.

    Kim TK, Park JH, Kim JY, Kim BC, Kang BM, Min SK, Kim JW (2018) Safety and feasibility of laparoscopic surgery for appendiceal mucocele: a multicenter study. Surg Endosc 32(11):4408–4414

    Article  Google Scholar 

  12. 12.

    González Moreno S, Shmookler BM, Sugarbaker PH (1998) Appendiceal mucocele. Contraindication to laparoscopic appendectomy. Surg Endosc 12(9):1177–1179

    Article  Google Scholar 

  13. 13.

    Sturniolo G, Barbuscia M, Taranto F, Tonante A, Paparo D, Romeo G, Nucera D, Lentini M (2011) Mucocele of the appendix. Two case reports. G Chir 32(11–12):487–490

    CAS  PubMed  Google Scholar 

  14. 14.

    Park KJ, Choi HJ, Kim SH (2015) Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases. Surg Endosc 29(11):3179–3183

    Article  Google Scholar 

  15. 15.

    Navarra G, Asopa V, Basaglia E, Jones M, Jiao LR, Habib NA (2003) Mucous cystadenoma of the appendix: is it safe to remove it by a laparoscopic approach? Surg Endosc 17(5):833–834

    CAS  Article  Google Scholar 

  16. 16.

    Lau H, Yuen WK, Loong F, Lee F (2002) Laparoscopic resection of an appendiceal mucocele. Surg Laparosc Endosc Percutan Tech 12(5):367–370

    Article  Google Scholar 

  17. 17.

    Ju YT, Park ST, Ha WS, Hong SC, Lee YJ, Jung EJ, Jung CY, Jeong SH, Choi SK (2011) Laparoscopic resection of a appendiceal mucocele. J Korean Surg Soc 80(Suppl 1):S21–S25

    Article  Google Scholar 

  18. 18.

    Behranwala KA, Agarwal T, El-Sharkawi D, Shorvon D, Chang A (2006) Laparoscopic resection of mucinous cystadenoma of appendix: a careful decision. Surg Laparosc Endosc Percutan Tech 16(5):347–348

    Article  Google Scholar 

  19. 19.

    Kaya C, Yazici P, Omeroglu S, Mihmanli M (2013) Laparoscopic appendectomy for appendiceal mucocele in an 83 years old woman. World J Gastrointest Surg 5(6):207–209

    Article  Google Scholar 

  20. 20.

    Palanivelu C, Rangarajan M, John SJ, Senthilkumar K, Annapoorni S (2008) Laparoscopic right hemicolectomy for mucocele due to a low-grade appendiceal mucinous neoplasm. JSLS 12(2):194–197

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Yoshida Y, Sato K, Tada T, Maekawa H, Sakurada M, Orita H, Ito T, Hirata F, Wada R (2013) Two cases of mucinous cystadenoma of the appendix successfully treated by laparoscopy. Case Rep Gastroenterol 7(1):44–48

    Article  Google Scholar 

  22. 22.

    Cho MS, Min BS, Hong YK, Lee WJ (2011) Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes. Surg Endosc 25(1):36–40

    Article  Google Scholar 

  23. 23.

    Park KB, Park JS, Choi GS, Kim HJ, Park SY, Ryuk JP, Choi WH, Jang YS (2011) Single-incision laparoscopic surgery for appendiceal mucoceles: safety and feasibility in a series of 16 consecutive cases. J Korean Soc Coloproctol 27(6):287–292

    Article  Google Scholar 

  24. 24.

    Fujino S, Miyoshi N, Noura S, Shingai T, Tomita Y, Ohue M, Yano M (2014) Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy. World J Gastrointest Surg 6(5):84–87

    Article  Google Scholar 

  25. 25.

    Vatansev C, Simsek G, Kucukkartallar T (2013) Single incision laparoscopic appendectomy with two port: a case of appendiceal mucocele. Indian J Surg 75(Suppl 1):382–384

    Article  Google Scholar 

  26. 26.

    Misdraji J, Young RH (2004) Primary epithelial neoplasms and other epithelial lesions of the appendix (excluding carcinoid tumors). Semin Diagn Pathol 21(2):120–133

    Article  Google Scholar 

  27. 27.

    Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23(10):1013–1016

    Article  Google Scholar 

  28. 28.

    Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10(8):823–826

    CAS  Article  Google Scholar 

  29. 29.

    Maggiori L, Gaujoux S, Tribillon E, Bretagnol F, Panis Y (2012) Single-incision laparoscopy for colorectal resection: a systematic review and meta-analysis of more than a thousand procedures. Colorectal Dis 14(10):e643–e654

    CAS  Article  Google Scholar 

  30. 30.

    Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK (2012) A double-blinded randomized controlled trial of laparoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 256(6):909–914

    Article  Google Scholar 

  31. 31.

    Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW (2014) A prospective, rnadomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg 218(5):950–909

    Article  Google Scholar 

  32. 32.

    Lee W, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH, Lee T (2013) Singe-port laparoscopic appendectomy versus conventional laparoscopic appendectomy. Ann Surg 257(2):214–218

    Article  Google Scholar 

  33. 33.

    Hesketh KT (1963) The management of primary adenocarcinoma of the vermiform appendix. Gut 4(2):158–168

    CAS  Article  Google Scholar 

  34. 34.

    González-Moreno S, Sugarbaker PH (2004) Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding. Br J Surg 91(3):304–311

    Article  Google Scholar 

  35. 35.

    Sugarbaker PH (2009) Epithelial appendiceal neoplasms. Cancer J 15(3):225–235

    Article  Google Scholar 

  36. 36.

    Misdraji J (2015) Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei. Mod Pathol 28(Suppl 1):S67–S79

    Article  Google Scholar 

  37. 37.

    Bosman FT, Carneiro F, Hruban RH, Theise ND, World Health Organization, International Agency for Research on Cancer (2010) WHO classification of tumours of the digestive system, 4th edn. International Agency for Research on Cancer, Lyon

    Google Scholar 

  38. 38.

    Tiselius C, Kindler C, Shetye J, Letocha H, Smedh K (2017) Computed tomography follow-up assessment of patients with low-grade appendiceal mucinous neoplasms: evaluation of risk for pseudomyxoma peritonei. Ann Surg Oncol 24(7):1778–1782

    Article  Google Scholar 

Download references

Funding

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Min Soo Cho.

Ethics declarations

Disclosures

Ho Seung Kim, Han-Gil Kim, Seung Yoon Yang, Yoon Dae Han, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, and Min Soo Cho have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, H.S., Kim, HG., Yang, S.Y. et al. Single-incision laparoscopic surgery compared to conventional laparoscopic surgery for appendiceal mucocele: a series of 116 patients. Surg Endosc (2021). https://doi.org/10.1007/s00464-020-08263-3

Download citation

Keywords

  • Appendix
  • Mucocele
  • Laparoscopic surgery
  • Single incision
  • Low-grade appendiceal mucinous neoplasm