1. Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy Results of the Multicenter, Prospective, Cross-Sectional FANCY Study
- Author
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Bastiaenen, Vivian P., de Jonge, Joske, Corten, Bartholomeus J. G. A., de Savornin Lohman, Elise A. J., Kraima, Anne C., Swank, Hilko A., van Vliet, Jaap L. P., van Acker, Gijs J. D., van Geloven, Anna A. W., in'tHof, Klaas H., Koens, Lianne, de Reuver, Philip R., van Rossem, Charles C., Slooter, Gerrit D., Tanis, Pieter J., Terpstra, Valeska, Dijkgraaf, Marcel G. W., Bemelman, Willem A., Amelung, F. J., Atema, J. J., Bessems, S., Beunders, A. A. M., Bodewes, T. C. F., den Boer, F. C., Boerma, D., Boerma, E. G., van den Boezem, P., Bökkerink, W. J. V., van den Boogaart, D., Boogerd, L. S. F., Bouwman, H., Broos, A., Brueren, L. O., Bruinsma, W. E., Bruns, E. R. C., Castelijns, P. S. S., de Castro, S. M. M., Consten, E. C. J., Crolla, R. M. P. H., Dam, M. J., Dang, Q., Dekker, J. W. T., Deroose, J. P., Devriendt, S., Dijkema, E. J., Dijkstra, N., Driessen, M. L. S., van Duijvendijk, P., Duinhouwer, L. E., van Duyn, E. B., el-Massoudi, Y., Elfrink, A. K. E., Elschot, J. H., van Essen, J. A., Ferenschild, F. T. J., Gans, S. L., Gaznay, C., Geraedts, A. C. M., van Gessel, B. S. H., Giesen, L. J. X., van Gils, N., Gorgec, B., Gorter, R. R., Govaert, K. M., Greuter, G. N., van Grevenstein, W. M. U., Groot, L., Hardy, J. C. A., Heemskerk, J., Heeren, J. F., Heidotting, J., Heikens, J. T., Hosseinzoi, E., van Iersel, J. J., Inberg, B., Jansen, L. J., Jens, A. J. T., Jilesen, A. P. J., Joosten, M., de Jong, L., Keijzers, M., Klicks, R. J., Kloppenberg, F. W. H., Koedam, T. W. A., Koëter, T., Konsten, J. L. M., Koolen, L. J. E. R., Kruyt, Ph. M., Lange, J. F. M., Lavrijssen, B. D. A., de Leede, E. M., Leliefeld, P. H. C., Linnemann, R. J. A., Lo, G. C., van de Loo, M., Lubbert, P. H. W., Holzik, M. F. Lutke, Manusama, E., Masselink, I., Matthée, E. P. C., Matthijsen, R. A., Mearadji, A., Melenhorst, J., Merkus, J. W. S., Michiels, T. D., Moes, D. E., Moossdorff, M., Mulder, E., Nallayici, E. G., Neijenhuis, P. A., Nielsen, K., Nieuwenhuijzen, G. A. P., Nijhuis, J., Okkema, S., Olthof, P. B., van Onkelen, R. S., van Oostendorp, S. E., Plaisier, P. W., Polle, S. W., Reiber, B. M. M., Reichert, F. C. M., van Rest, K. L. C., van Rijn, R., Roozendaal, N. C., de Ruijter, W. M. J., Schat, E., Scheerhoorn, J., Scheijmans, J. C. G., Schimmer, J., Schipper, R. J., Schouten, R., Schreurs, W. H., Schrijver, W. A. M. E., Shapiro, J., Siemons, A., Silvis, R., Simkens, G. A., Smakman, N., Smeets, B. J. J., Sonneveld, D. J. A., van Suijlichem, M., Talsma, A. K., Thoolen, J. M. M., van Tol, R. R., Tournoij, E., Tseng, L. N. L., Tuynman, J. B., van der Velde, K., Veltkamp, S. C., Verbeek, F. P. R., Verdaasdonk, E., Verhaak, T., Verheuvel, N. C., Vermaas, M., Verseveld, M., Vlek, S., Vogels, S., van de Voort, E. M. F., van Vugt, S. T., Wegdam, J. A., Wennekers, M. M., Wiering, B., de Wijkerslooth, E. M. L., Wijkmans, A. A., Wijnhoven, B. P. L., Witjes, C. D. M., Wolfhagen, N., de Zeeuw, S., van Zoonen, G., Surgery, Erasmus MC other, Obstetrics & Gynecology, Department of Strategic Management and Entrepreneurship, Neurology, Rotterdam School of Management, Cardiology, Gastroenterology & Hepatology, Radiology & Nuclear Medicine, Otorhinolaryngology and Head and Neck Surgery, Emergency Medicine, Public Health, Plastic and Reconstructive Surgery and Hand Surgery, Dermatology, Clinical Chemistry, Internal Medicine, Erasmus School of Social and Behavioural Sciences, General Practice, Radiotherapy, Research & Education, Rehabilitation Medicine, Urology, Pathology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Hematology laboratory, VU University medical center, CCA - Cancer Treatment and quality of life, and CCA - Imaging and biomarkers
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medicine.medical_specialty ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,All institutes and research themes of the Radboud University Medical Center ,business.industry ,General surgery ,Medicine ,Surgery ,Histopathological examination ,business ,Cost savings - Abstract
Objective: To investigate the oncological safety and potential cost savings of selective histopathological examination after appendectomy. Background: The necessity of routine histopathological examination after 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% confidence interval below 3:1000 considered oncologically safe) and potential cost savings after selective histopathological examination. Results: Seven thousand three hundred thirty-nine patients were included. After 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% confidence interval 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 725,400 per 10,000 patients. Conclusions: Selective histopathological examination after 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.
- Published
- 2023