Vivian P Bastiaenen1, Joske de Jonge2, Bartholomeus J G A Corten3, Elise A J de Savornin Lohman4, Anne C Kraima1,5, Hilko A Swank1,5, Jaap L P van Vliet6, Gijs J D van Acker6, Anna A W van Geloven2, Klaas H 't In Hof7, Lianne Koens8, Philip R de Reuver4, Charles van Rossem9, Gerrit D Slooter9, Pieter J Tanis1, Valeska Terpstra10, Marcel G W Dijkgraaf11, Willem A Bemelman1. 1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 2. Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands. 3. Department of Surgery, Maxima Medical Center, Veldhoven, the Netherlands. 4. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. 5. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 6. Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands. 7. Department of Surgery, Flevo Hospital, Almere, the Netherlands. 8. Department of Pathology, Amsterdam UMC, University of Amsterdam, the Netherlands. 9. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. 10. Department of Pathology, Haaglanden Medical Center, The Hague, the Netherlands. 11. Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To investigate the oncological safety and potential cost savings of selective histopathological examination following appendectomy. SUMMARY BACKGROUND DATA: The necessity of routine histopathological examination following appendectomy has been questioned, but prospective studies investigating the safety of a selective policy are lacking. METHODS: In this multicenter, prospective, cross-sectional study, inspection and palpation of the (meso)appendix was performed by the surgeon in patients with suspected appendicitis. The surgeon's opinion on additional value of histopathological examination was reported before sending all specimens to the pathologist. Main outcomes were the number of hypothetically missed appendiceal neoplasms with clinical consequences benefiting the patient (upper limit two-sided 95% CI below 3:1000 considered oncologically safe) and potential cost savings following selective histopathological examination. RESULTS: 7339 patients were included. Following a selective policy, 4966/7339 (67.7%) specimens would have been refrained from histopathological examination. Appendiceal neoplasms with clinical consequences would have been missed in 22/4966 patients. In 5/22, residual disease was completely resected during additional surgery. Hence, an appendiceal neoplasm with clinical consequences benefiting the patient would have been missed in 1.01:1000 patients (upper limit 95% CI 1.61:1000). In contrast, twice as many patients (10/22) would not have been exposed to potential harm due to re-resections without clear benefit, whereas consequences were neither beneficial nor harmful in the remaining seven. Estimated cost savings established by replacing routine for selective histopathological examination were [Euro sign]725,400 per 10,000 patients. CONCLUSIONS: Selective histopathological examination following appendectomy for suspected appendicitis is oncologically safe and will likely result in a reduction of pathologists' workload, less costs, and fewer re-resections without clear benefit. Copyright (C) 2022 Wolters Kluwer Health, Inc. All rights reserved.
OBJECTIVE: To investigate the oncological safety and potential cost savings of selective histopathological examination following appendectomy. SUMMARY BACKGROUND DATA: The necessity of routine histopathological examination following appendectomy has been questioned, but prospective studies investigating the safety of a selective policy are lacking. METHODS: In this multicenter, prospective, cross-sectional study, inspection and palpation of the (meso)appendix was performed by the surgeon in patients with suspected appendicitis. The surgeon's opinion on additional value of histopathological examination was reported before sending all specimens to the pathologist. Main outcomes were the number of hypothetically missed appendiceal neoplasms with clinical consequences benefiting the patient (upper limit two-sided 95% CI below 3:1000 considered oncologically safe) and potential cost savings following selective histopathological examination. RESULTS: 7339 patients were included. Following a selective policy, 4966/7339 (67.7%) specimens would have been refrained from histopathological examination. Appendiceal neoplasms with clinical consequences would have been missed in 22/4966 patients. In 5/22, residual disease was completely resected during additional surgery. Hence, an appendiceal neoplasm with clinical consequences benefiting the patient would have been missed in 1.01:1000 patients (upper limit 95% CI 1.61:1000). In contrast, twice as many patients (10/22) would not have been exposed to potential harm due to re-resections without clear benefit, whereas consequences were neither beneficial nor harmful in the remaining seven. Estimated cost savings established by replacing routine for selective histopathological examination were [Euro sign]725,400 per 10,000 patients. CONCLUSIONS: Selective histopathological examination following appendectomy for suspected appendicitis is oncologically safe and will likely result in a reduction of pathologists' workload, less costs, and fewer re-resections without clear benefit. Copyright (C) 2022 Wolters Kluwer Health, Inc. All rights reserved.