Management of 1- to 2-cm XXXX of the Appendix: Using the National Cancer Data Base to Address Controversies in General Surgery.

@entity5 @entity1 @entity4265 @entity4303
BACKGROUND: The management of 1- to 2-cm appendiceal @entity5 remains controversial. Here we use the National Cancer Data Base (NCDB) to compare long-term outcomes for @entity1 treated via resection of the @entity5 alone vs @entity4265 ( @entity4265 ). STUDY DESIGN: The 1998 to 2011 NCDB User File was queried to identify @entity1 with 1- to 2-cm appendiceal @entity4303 . @entity1 were stratified by surgical technique: resection of the @entity5 alone vs @entity4265 with regional lymphadenectomy. Multivariable logistic regression was used to compare short-term outcomes. Survival was estimated using the Kaplan-Meier method with comparisons based on the log-rank test. RESULTS: A total of 916 @entity1 were identified, including 42% managed with primary resection and 58% with @entity4265 . @entity1 who underwent @entity4265 had slightly larger @entity5 and @entity5 ; otherwise, there were no baseline differences between groups. The rates of positive margins were similar (5.5% vs 4.5%; p  = 0.60). Among all @entity1 , 1- and 5-year survival were 98.1% and 88.7% vs 96.7% and 87.4% (p  = 0.52) for those managed via primary resection vs @entity4265 , respectively. Among @entity1 with moderate/high-grade/anaplastic @entity4303 , 1- and 5-year survival were 93.3% and 72.0% vs 92.3% and 71.9%, respectively (p  = 0.78). After adjustment with Cox proportional hazards modeling, we confirmed that there was no survival benefit for @entity1 undergoing @entity4265 (hazard ratio  = 1.14; p  = 0.72). CONCLUSIONS: For 1- to 2-cm appendiceal @entity4303 , formal resection of the right colon does not appear to improve survival, even for higher-grade @entity5 . Our findings suggest that resection of the @entity5 alone is adequate for all @entity4303 <2 cm.
