Risk factors for appendiceal involvement in women with epithelial ovarian cancer

OBJECTIVE: To evaluate the risk factors for appendiceal involvement in women with epithelial ovarian cancer (EOC) who underwent appendectomy at the time of initial surgery. MATERIAL AND METHODS: Patients with a final diagnosis of EOC who underwent appendectomy at the time of initial surgery were evaluated retrospectively. Risk factors related to the presence of appendiceal involvement were analyzed. RESULTS: A total of 210 patients underwent appendectomy during staging surgery. Appendiceal involvement was detected in 61 patients. No women with apparent clinical early-stage tumors had evidence of isolated metastatic disease to the appendix; therefore, no upstaging was detected due to solitary appendiceal involvement in this group of patients. For all patients, univariate analysis of the appendiceal involvement revealed age, stage, grade, extragenital organ involvement (omentum, bowel, peritoneum), positive cytology, and lymph node metastasis as significant factors (p<0.05). In the multivariate analysis, appendiceal involvement was significantly affected by age and omental involvement. Older age (>50 years) [odds ratio (OR) 2.8; 95% confidence interval (CI): (1.24-6.37); p=0.014] and presence of omental involvement [OR: 3.2; 95% CI: (1.22-8.59); p=0.018) seemed to be independent risk factors for appendiceal involvement in women with EOC. CONCLUSION: Our findings indicate that routine appendectomy at the time of surgery for apparent early-stage EOC is not warranted. Nevertheless, the surgeon can take the initiative in regards to performing appendectomy because the morbidity rates due to this procedure are negligible. Older age (>50 years) and presence of omental involvement seem to increase the risk of appendiceal involvement by 2.8 and 3.2 times, respectively.