Role of appendectomy at the time of primary surgery in patients with early-stage ovarian cancer

Objective. To determine whether appendectomy is warranted in patients with apparent early-stage ovarian cancer who undergo surgery for staging and cytoreduction and to determine the complication rate associated with appendectomy in such patients. Methods. We reviewed the medical records of all patients who underwent appendectomy at the time of primary surgery for ovarian cancer at The University of Texas M. D. Anderson Cancer Center between January 1992 and December 2004 and who did not meet any of the following exclusion criteria: stage III or IV ovarian cancer, appendectomy as part of a second-look procedure or secondary tumor-reductive surgery, primary appendiceal cancer, primary gastrointestinal malignancy with metastasis to the appendix, incomplete clinicopathologic data, appendicitis as a preoperative diagnosis, primary fallopian tube cancer, primary peritoneal cancer, or documented dual primary tumors. Results. Fifty-seven patients were included in this analysis. The median age was 47 years (range, 13–75). Median follow-up was 53 months (range, 3–147). Histologic diagnoses were as follows: invasive epithelial carcinoma, 35 patients (61%); tumor of low malignant potential, 15 patients (26%); malignant germ cell tumor, 4 patients (7%); and other, 3 patients (5%). Twenty-three patients (40%) had pure mucinous tumors. Forty-six patients (81%) had stage I and 11 patients (19%) had stage II disease. The median CA-125 level was 36.2 U/mL (range, 7–7900). No patient had evidence of appendiceal involvement. No patient suffered an intraoperative or postoperative complication directly related to appendectomy. Conclusions. Appendectomy at the time of surgery for apparent early-stage ovarian cancer is not associated with complications but should not be routinely recommended.