Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study

Vivian P. Bastiaenen; Joske de Jonge; Bartholomeus J. G. A. Corten; Elise A. J. de Savornin Lohman; Anne C. Kraima; Hilko A. Swank; Jaap L. P. van Vliet; Gijs J. D. van Acker; Anna A. W. van Geloven; Klaas H. in'tHof; Lianne Koens; Philip R. de Reuver; Charles C. van Rossem; Gerrit D. Slooter; Pieter J. Tanis; Valeska Terpstra; Marcel G. W. Dijkgraaf; Willem A. Bemelman; F. J. Amelung; J. J. Atema; S. Bessems; A. A. M. Beunders; T. C. F. Bodewes; F. C. den Boer; D. Boerma; E. G. Boerma; P. van den Boezem; W. J. V. Bökkerink; D. van den Boogaart; L. S. F. Boogerd; H. Bouwman; A. Broos; L. O. Brueren; W. E. Bruinsma; E. R. C. Bruns; P. S. S. Castelijns; S. M. M. de Castro; E. C. J. Consten; R. M. P. H. Crolla; M. J. Dam; Q. Dang; J. W. T. Dekker; J. P. Deroose; S. Devriendt; E. J. Dijkema; N. Dijkstra; M. L. S. Driessen; P. van Duijvendijk; L. E. Duinhouwer; E. B. van Duyn; Y. el-Massoudi; A. K. E. Elfrink; J. H. Elschot; J. A. van Essen; F. T. J. Ferenschild; S. L. Gans; C. Gaznay; A. C. M. Geraedts; B. S. H. van Gessel; L. J. X. Giesen; N. van Gils; B. Gorgec; R. R. Gorter; K. M. Govaert; G. N. Greuter; W. M. U. van Grevenstein; L. Groot; J. C. A. Hardy; J. Heemskerk; J. F. Heeren; J. Heidotting; J. T. Heikens; E. Hosseinzoi; J. J. van Iersel; B. Inberg; L. J. Jansen; A. J. T. Jens; A. P. J. Jilesen; M. Joosten; L. de Jong; M. Keijzers; R. J. Klicks; F. W. H. Kloppenberg; T. W. A. Koedam; T. Koëter; J. L. M. Konsten; L. J. E. R. Koolen; Ph. M. Kruyt; J. F. M. Lange; B. D. A. Lavrijssen; E. M. de Leede; P. H. C. Leliefeld; R. J. A. Linnemann; G. C. Lo; M. van de Loo; P. H. W. Lubbert; M. F. Lutke Holzik; E. Manusama; I. Masselink; E. P. C. Matthée; R. A. Matthijsen; A. Mearadji; J. Melenhorst; J. W. S. Merkus; T. D. Michiels; D. E. Moes; M. Moossdorff; E. Mulder; E. G. Nallayici; P. A. Neijenhuis; K. Nielsen; G. A. P. Nieuwenhuijzen; J. Nijhuis; S. Okkema; P. B. Olthof; R. S. van Onkelen; S. E. van Oostendorp; P. W. Plaisier; S. W. Polle; B. M. M. Reiber; F. C. M. Reichert; K. L. C. van Rest; R. van Rijn; N. C. Roozendaal; W. M. J. de Ruijter; E. Schat; J. Scheerhoorn; J. C. G. Scheijmans; J. Schimmer; R. J. Schipper; R. Schouten; W. H. Schreurs; W. A. M. E. Schrijver; J. Shapiro; A. Siemons; R. Silvis; G. A. Simkens; N. Smakman; B. J. J. Smeets; D. J. A. Sonneveld; M. van Suijlichem; A. K. Talsma; J. M. M. Thoolen; R. R. van Tol; E. Tournoij; L. N. L. Tseng; J. B. Tuynman; K. van der Velde; S. C. Veltkamp; F. P. R. Verbeek; E. Verdaasdonk; T. Verhaak; N. C. Verheuvel; M. Vermaas; M. Verseveld; S. Vlek; S. Vogels; E. M. F. van de Voort; S. T. van Vugt; J. A. Wegdam; M. M. Wennekers; B. Wiering; E. M. L. de Wijkerslooth; A. A. Wijkmans; B. P. L. Wijnhoven; C. D. M. Witjes; N. Wolfhagen; S. de Zeeuw; G. van Zoonen

doi:https://doi.org/10.1097/SLA.0000000000005228

Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study

Vivian P. Bastiaenen, Joske de Jonge, Bartholomeus J. G. A. Corten, Elise A. J. de Savornin Lohman, Anne C. Kraima, Hilko A. Swank, Jaap L. P. van Vliet, Gijs J. D. van Acker, Anna A. W. van Geloven, Klaas H. in'tHof, Lianne Koens, Philip R. de Reuver, Charles C. van Rossem, Gerrit D. Slooter, Pieter J. Tanis, Valeska Terpstra, Marcel G. W. Dijkgraaf, Willem A. Bemelman, F. J. Amelung, J. J. AtemaS. Bessems, A. A. M. Beunders, T. C. F. Bodewes, F. C. den Boer, D. Boerma, E. G. Boerma, P. van den Boezem, W. J. V. Bökkerink, D. van den Boogaart, L. S. F. Boogerd, H. Bouwman, A. Broos, L. O. Brueren, W. E. Bruinsma, E. R. C. Bruns, P. S. S. Castelijns, S. M. M. de Castro, E. C. J. Consten, R. M. P. H. Crolla, M. J. Dam, Q. Dang, J. W. T. Dekker, J. P. Deroose, S. Devriendt, E. J. Dijkema, N. Dijkstra, M. L. S. Driessen, P. van Duijvendijk, L. E. Duinhouwer, E. B. van Duyn, Y. el-Massoudi, A. K. E. Elfrink, J. H. Elschot, J. A. van Essen, F. T. J. Ferenschild, S. L. Gans, C. Gaznay, A. C. M. Geraedts, B. S. H. van Gessel, L. J. X. Giesen, N. van Gils, B. Gorgec, R. R. Gorter, K. M. Govaert, G. N. Greuter, W. M. U. van Grevenstein, L. Groot, J. C. A. Hardy, J. Heemskerk, J. F. Heeren, J. Heidotting, J. T. Heikens, E. Hosseinzoi, J. J. van Iersel, B. Inberg, L. J. Jansen, A. J. T. Jens, A. P. J. Jilesen, M. Joosten, L. de Jong, M. Keijzers, R. J. Klicks, F. W. H. Kloppenberg, T. W. A. Koedam, T. Koëter, J. L. M. Konsten, L. J. E. R. Koolen, Ph. M. Kruyt, J. F. M. Lange, B. D. A. Lavrijssen, E. M. de Leede, P. H. C. Leliefeld, R. J. A. Linnemann, G. C. Lo, M. van de Loo, P. H. W. Lubbert, M. F. Lutke Holzik, E. Manusama, I. Masselink, E. P. C. Matthée, R. A. Matthijsen, A. Mearadji, J. Melenhorst, J. W. S. Merkus, T. D. Michiels, D. E. Moes, M. Moossdorff, E. Mulder, E. G. Nallayici, P. A. Neijenhuis, K. Nielsen, G. A. P. Nieuwenhuijzen, J. Nijhuis, S. Okkema, P. B. Olthof, R. S. van Onkelen, S. E. van Oostendorp, P. W. Plaisier, S. W. Polle, B. M. M. Reiber, F. C. M. Reichert, K. L. C. van Rest, R. van Rijn, N. C. Roozendaal, W. M. J. de Ruijter, E. Schat, J. Scheerhoorn, J. C. G. Scheijmans, J. Schimmer, R. J. Schipper, R. Schouten, W. H. Schreurs, W. A. M. E. Schrijver, J. Shapiro, A. Siemons, R. Silvis, G. A. Simkens, N. Smakman, B. J. J. Smeets, D. J. A. Sonneveld, M. van Suijlichem, A. K. Talsma, J. M. M. Thoolen, R. R. van Tol, E. Tournoij, L. N. L. Tseng, J. B. Tuynman, K. van der Velde, S. C. Veltkamp, F. P. R. Verbeek, E. Verdaasdonk, T. Verhaak, N. C. Verheuvel, M. Vermaas, M. Verseveld, S. Vlek, S. Vogels, E. M. F. van de Voort, S. T. van Vugt, J. A. Wegdam, M. M. Wennekers, B. Wiering, E. M. L. de Wijkerslooth, A. A. Wijkmans, B. P. L. Wijnhoven, C. D. M. Witjes, N. Wolfhagen, S. de Zeeuw, G. van Zoonen

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

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.

Original language	English
Pages (from-to)	E578-E584
Journal	Annals of surgery
Volume	277
Issue number	3
DOIs	https://doi.org/10.1097/SLA.0000000000005228
Publication status	Published - 1 Mar 2023

Keywords

appendectomy
appendicitis
histopathology
pathology
routine
selective

Access to Document

https://doi.org/10.1097/SLA.0000000000005228

Cite this

Bastiaenen, V. P., de Jonge, J., Corten, B. J. G. A., de Savornin Lohman, E. A. J., Kraima, A. C., Swank, H. A., van Vliet, J. L. P., van Acker, G. J. D., van Geloven, A. A. W., in'tHof, K. H., Koens, L., de Reuver, P. R., van Rossem, C. C., Slooter, G. D., Tanis, P. J., Terpstra, V., Dijkgraaf, M. G. W., Bemelman, W. A., Amelung, F. J., ... van Zoonen, G. (2023). Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study. Annals of surgery, 277(3), E578-E584. https://doi.org/10.1097/SLA.0000000000005228

@article{d29c9e9918ec4153b1c589ca3a496227,

title = "Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study",

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.",

keywords = "appendectomy, appendicitis, histopathology, pathology, routine, selective",

author = "Bastiaenen, {Vivian P.} and {de Jonge}, Joske and Corten, {Bartholomeus J. G. A.} and {de Savornin Lohman}, {Elise A. J.} and Kraima, {Anne C.} and Swank, {Hilko A.} and {van Vliet}, {Jaap L. P.} and {van Acker}, {Gijs J. D.} and {van Geloven}, {Anna A. W.} and in'tHof, {Klaas H.} and Lianne Koens and {de Reuver}, {Philip R.} and {van Rossem}, {Charles C.} and Slooter, {Gerrit D.} and Tanis, {Pieter J.} and Valeska Terpstra and Dijkgraaf, {Marcel G. W.} and Bemelman, {Willem A.} and Amelung, {F. J.} and Atema, {J. J.} and S. Bessems and Beunders, {A. A. M.} and Bodewes, {T. C. F.} and {den Boer}, {F. C.} and D. Boerma and Boerma, {E. G.} and {van den Boezem}, P. and B{\"o}kkerink, {W. J. V.} and {van den Boogaart}, D. and Boogerd, {L. S. F.} and H. Bouwman and A. Broos and Brueren, {L. O.} and Bruinsma, {W. E.} and Bruns, {E. R. C.} and Castelijns, {P. S. S.} and {de Castro}, {S. M. M.} and Consten, {E. C. J.} and Crolla, {R. M. P. H.} and Dam, {M. J.} and Q. Dang and Dekker, {J. W. T.} and Deroose, {J. P.} and S. Devriendt and Dijkema, {E. J.} and N. Dijkstra and Driessen, {M. L. S.} and {van Duijvendijk}, P. and Duinhouwer, {L. E.} and {van Duyn}, {E. B.} and Y. el-Massoudi and Elfrink, {A. K. E.} and Elschot, {J. H.} and {van Essen}, {J. A.} and Ferenschild, {F. T. J.} and Gans, {S. L.} and C. Gaznay and Geraedts, {A. C. M.} and {van Gessel}, {B. S. H.} and Giesen, {L. J. X.} and {van Gils}, N. and B. Gorgec and Gorter, {R. R.} and Govaert, {K. M.} and Greuter, {G. N.} and {van Grevenstein}, {W. M. U.} and L. Groot and Hardy, {J. C. A.} and J. Heemskerk and Heeren, {J. F.} and J. Heidotting and Heikens, {J. T.} and E. Hosseinzoi and {van Iersel}, {J. J.} and B. Inberg and Jansen, {L. J.} and Jens, {A. J. T.} and Jilesen, {A. P. J.} and M. Joosten and {de Jong}, L. and M. Keijzers and Klicks, {R. J.} and Kloppenberg, {F. W. H.} and Koedam, {T. W. A.} and T. Ko{\"e}ter and Konsten, {J. L. M.} and Koolen, {L. J. E. R.} and Kruyt, {Ph. M.} and Lange, {J. F. M.} and Lavrijssen, {B. D. A.} and {de Leede}, {E. M.} and Leliefeld, {P. H. C.} and Linnemann, {R. J. A.} and Lo, {G. C.} and {van de Loo}, M. and Lubbert, {P. H. W.} and Holzik, {M. F. Lutke} and E. Manusama and I. Masselink and Matth{\'e}e, {E. P. C.} and Matthijsen, {R. A.} and A. Mearadji and J. Melenhorst and Merkus, {J. W. S.} and Michiels, {T. D.} and Moes, {D. E.} and M. Moossdorff and E. Mulder and Nallayici, {E. G.} and Neijenhuis, {P. A.} and K. Nielsen and Nieuwenhuijzen, {G. A. P.} and J. Nijhuis and S. Okkema and Olthof, {P. B.} and {van Onkelen}, {R. S.} and {van Oostendorp}, {S. E.} and Plaisier, {P. W.} and Polle, {S. W.} and Reiber, {B. M. M.} and Reichert, {F. C. M.} and {van Rest}, {K. L. C.} and {van Rijn}, R. and Roozendaal, {N. C.} and {de Ruijter}, {W. M. J.} and E. Schat and J. Scheerhoorn and Scheijmans, {J. C. G.} and J. Schimmer and Schipper, {R. J.} and R. Schouten and Schreurs, {W. H.} and Schrijver, {W. A. M. E.} and J. Shapiro and A. Siemons and R. Silvis and Simkens, {G. A.} and N. Smakman and Smeets, {B. J. J.} and Sonneveld, {D. J. A.} and {van Suijlichem}, M. and Talsma, {A. K.} and Thoolen, {J. M. M.} and {van Tol}, {R. R.} and E. Tournoij and Tseng, {L. N. L.} and Tuynman, {J. B.} and {van der Velde}, K. and Veltkamp, {S. C.} and Verbeek, {F. P. R.} and E. Verdaasdonk and T. Verhaak and Verheuvel, {N. C.} and M. Vermaas and M. Verseveld and S. Vlek and S. Vogels and {van de Voort}, {E. M. F.} and {van Vugt}, {S. T.} and Wegdam, {J. A.} and Wennekers, {M. M.} and B. Wiering and {de Wijkerslooth}, {E. M. L.} and Wijkmans, {A. A.} and Wijnhoven, {B. P. L.} and Witjes, {C. D. M.} and N. Wolfhagen and {de Zeeuw}, S. and {van Zoonen}, G.",

note = "Funding Information: This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw), of which the Dutch Ministry of Health, Welfare and Sports, and the Dutch Organisation for Scientific Research are the main commissioning organisations. The funder of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = mar,

day = "1",

doi = "https://doi.org/10.1097/SLA.0000000000005228",

language = "English",

volume = "277",

pages = "E578--E584",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Bastiaenen, VP, de Jonge, J, Corten, BJGA, de Savornin Lohman, EAJ, Kraima, AC, Swank, HA, van Vliet, JLP, van Acker, GJD, van Geloven, AAW, in'tHof, KH, Koens, L, de Reuver, PR, van Rossem, CC, Slooter, GD, Tanis, PJ, Terpstra, V, Dijkgraaf, MGW, Bemelman, WA, Amelung, FJ, Atema, JJ, Bessems, S, Beunders, AAM, Bodewes, TCF, den Boer, FC, Boerma, D, Boerma, EG, van den Boezem, P, Bökkerink, WJV, van den Boogaart, D, Boogerd, LSF, Bouwman, H, Broos, A, Brueren, LO, Bruinsma, WE, Bruns, ERC, Castelijns, PSS, de Castro, SMM, Consten, ECJ, Crolla, RMPH, Dam, MJ, Dang, Q, Dekker, JWT, Deroose, JP, Devriendt, S, Dijkema, EJ, Dijkstra, N, Driessen, MLS, van Duijvendijk, P, Duinhouwer, LE, van Duyn, EB, el-Massoudi, Y, Elfrink, AKE, Elschot, JH, van Essen, JA, Ferenschild, FTJ, Gans, SL, Gaznay, C, Geraedts, ACM, van Gessel, BSH, Giesen, LJX, van Gils, N, Gorgec, B, Gorter, RR, Govaert, KM, Greuter, GN, van Grevenstein, WMU, Groot, L, Hardy, JCA, Heemskerk, J, Heeren, JF, Heidotting, J, Heikens, JT, Hosseinzoi, E, van Iersel, JJ, Inberg, B, Jansen, LJ, Jens, AJT, Jilesen, APJ, Joosten, M, de Jong, L, Keijzers, M, Klicks, RJ, Kloppenberg, FWH, Koedam, TWA, Koëter, T, Konsten, JLM, Koolen, LJER, Kruyt, PM, Lange, JFM, Lavrijssen, BDA, de Leede, EM, Leliefeld, PHC, Linnemann, RJA, Lo, GC, van de Loo, M, Lubbert, PHW, Holzik, MFL, Manusama, E, Masselink, I, Matthée, EPC, Matthijsen, RA, Mearadji, A, Melenhorst, J, Merkus, JWS, Michiels, TD, Moes, DE, Moossdorff, M, Mulder, E, Nallayici, EG, Neijenhuis, PA, Nielsen, K, Nieuwenhuijzen, GAP, Nijhuis, J, Okkema, S, Olthof, PB, van Onkelen, RS, van Oostendorp, SE, Plaisier, PW, Polle, SW, Reiber, BMM, Reichert, FCM, van Rest, KLC, van Rijn, R, Roozendaal, NC, de Ruijter, WMJ, Schat, E, Scheerhoorn, J, Scheijmans, JCG, Schimmer, J, Schipper, RJ, Schouten, R, Schreurs, WH, Schrijver, WAME, Shapiro, J, Siemons, A, Silvis, R, Simkens, GA, Smakman, N, Smeets, BJJ, Sonneveld, DJA, van Suijlichem, M, Talsma, AK, Thoolen, JMM, van Tol, RR, Tournoij, E, Tseng, LNL, Tuynman, JB, van der Velde, K, Veltkamp, SC, Verbeek, FPR, Verdaasdonk, E, Verhaak, T, Verheuvel, NC, Vermaas, M, Verseveld, M, Vlek, S, Vogels, S, van de Voort, EMF, van Vugt, ST, Wegdam, JA, Wennekers, MM, Wiering, B, de Wijkerslooth, EML, Wijkmans, AA, Wijnhoven, BPL, Witjes, CDM, Wolfhagen, N, de Zeeuw, S & van Zoonen, G 2023, 'Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study', Annals of surgery, vol. 277, no. 3, pp. E578-E584. https://doi.org/10.1097/SLA.0000000000005228

Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study. / Bastiaenen, Vivian P.; de Jonge, Joske; Corten, Bartholomeus J. G. A. et al.
In: Annals of surgery, Vol. 277, No. 3, 01.03.2023, p. E578-E584.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy

T2 - Results of the Multicenter, Prospective, Cross-Sectional FANCY Study

AU - Bastiaenen, Vivian P.

AU - de Jonge, Joske

AU - Corten, Bartholomeus J. G. A.

AU - de Savornin Lohman, Elise A. J.

AU - Kraima, Anne C.

AU - Swank, Hilko A.

AU - van Vliet, Jaap L. P.

AU - van Acker, Gijs J. D.

AU - van Geloven, Anna A. W.

AU - in'tHof, Klaas H.

AU - Koens, Lianne

AU - de Reuver, Philip R.

AU - van Rossem, Charles C.

AU - Slooter, Gerrit D.

AU - Tanis, Pieter J.

AU - Terpstra, Valeska

AU - Dijkgraaf, Marcel G. W.

AU - Bemelman, Willem A.

AU - Amelung, F. J.

AU - Atema, J. J.

AU - Bessems, S.

AU - Beunders, A. A. M.

AU - Bodewes, T. C. F.

AU - den Boer, F. C.

AU - Boerma, D.

AU - Boerma, E. G.

AU - van den Boezem, P.

AU - Bökkerink, W. J. V.

AU - van den Boogaart, D.

AU - Boogerd, L. S. F.

AU - Bouwman, H.

AU - Broos, A.

AU - Brueren, L. O.

AU - Bruinsma, W. E.

AU - Bruns, E. R. C.

AU - Castelijns, P. S. S.

AU - de Castro, S. M. M.

AU - Consten, E. C. J.

AU - Crolla, R. M. P. H.

AU - Dam, M. J.

AU - Dang, Q.

AU - Dekker, J. W. T.

AU - Deroose, J. P.

AU - Devriendt, S.

AU - Dijkema, E. J.

AU - Dijkstra, N.

AU - Driessen, M. L. S.

AU - van Duijvendijk, P.

AU - Duinhouwer, L. E.

AU - van Duyn, E. B.

AU - el-Massoudi, Y.

AU - Elfrink, A. K. E.

AU - Elschot, J. H.

AU - van Essen, J. A.

AU - Ferenschild, F. T. J.

AU - Gans, S. L.

AU - Gaznay, C.

AU - Geraedts, A. C. M.

AU - van Gessel, B. S. H.

AU - Giesen, L. J. X.

AU - van Gils, N.

AU - Gorgec, B.

AU - Gorter, R. R.

AU - Govaert, K. M.

AU - Greuter, G. N.

AU - van Grevenstein, W. M. U.

AU - Groot, L.

AU - Hardy, J. C. A.

AU - Heemskerk, J.

AU - Heeren, J. F.

AU - Heidotting, J.

AU - Heikens, J. T.

AU - Hosseinzoi, E.

AU - van Iersel, J. J.

AU - Inberg, B.

AU - Jansen, L. J.

AU - Jens, A. J. T.

AU - Jilesen, A. P. J.

AU - Joosten, M.

AU - de Jong, L.

AU - Keijzers, M.

AU - Klicks, R. J.

AU - Kloppenberg, F. W. H.

AU - Koedam, T. W. A.

AU - Koëter, T.

AU - Konsten, J. L. M.

AU - Koolen, L. J. E. R.

AU - Kruyt, Ph. M.

AU - Lange, J. F. M.

AU - Lavrijssen, B. D. A.

AU - de Leede, E. M.

AU - Leliefeld, P. H. C.

AU - Linnemann, R. J. A.

AU - Lo, G. C.

AU - van de Loo, M.

AU - Lubbert, P. H. W.

AU - Holzik, M. F. Lutke

AU - Manusama, E.

AU - Masselink, I.

AU - Matthée, E. P. C.

AU - Matthijsen, R. A.

AU - Mearadji, A.

AU - Melenhorst, J.

AU - Merkus, J. W. S.

AU - Michiels, T. D.

AU - Moes, D. E.

AU - Moossdorff, M.

AU - Mulder, E.

AU - Nallayici, E. G.

AU - Neijenhuis, P. A.

AU - Nielsen, K.

AU - Nieuwenhuijzen, G. A. P.

AU - Nijhuis, J.

AU - Okkema, S.

AU - Olthof, P. B.

AU - van Onkelen, R. S.

AU - van Oostendorp, S. E.

AU - Plaisier, P. W.

AU - Polle, S. W.

AU - Reiber, B. M. M.

AU - Reichert, F. C. M.

AU - van Rest, K. L. C.

AU - van Rijn, R.

AU - Roozendaal, N. C.

AU - de Ruijter, W. M. J.

AU - Schat, E.

AU - Scheerhoorn, J.

AU - Scheijmans, J. C. G.

AU - Schimmer, J.

AU - Schipper, R. J.

AU - Schouten, R.

AU - Schreurs, W. H.

AU - Schrijver, W. A. M. E.

AU - Shapiro, J.

AU - Siemons, A.

AU - Silvis, R.

AU - Simkens, G. A.

AU - Smakman, N.

AU - Smeets, B. J. J.

AU - Sonneveld, D. J. A.

AU - van Suijlichem, M.

AU - Talsma, A. K.

AU - Thoolen, J. M. M.

AU - van Tol, R. R.

AU - Tournoij, E.

AU - Tseng, L. N. L.

AU - Tuynman, J. B.

AU - van der Velde, K.

AU - Veltkamp, S. C.

AU - Verbeek, F. P. R.

AU - Verdaasdonk, E.

AU - Verhaak, T.

AU - Verheuvel, N. C.

AU - Vermaas, M.

AU - Verseveld, M.

AU - Vlek, S.

AU - Vogels, S.

AU - van de Voort, E. M. F.

AU - van Vugt, S. T.

AU - Wegdam, J. A.

AU - Wennekers, M. M.

AU - Wiering, B.

AU - de Wijkerslooth, E. M. L.

AU - Wijkmans, A. A.

AU - Wijnhoven, B. P. L.

AU - Witjes, C. D. M.

AU - Wolfhagen, N.

AU - de Zeeuw, S.

AU - van Zoonen, G.

N1 - Funding Information: This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw), of which the Dutch Ministry of Health, Welfare and Sports, and the Dutch Organisation for Scientific Research are the main commissioning organisations. The funder of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

PY - 2023/3/1

Y1 - 2023/3/1

N2 - 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.

AB - 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.

KW - appendectomy

KW - appendicitis

KW - histopathology

KW - pathology

KW - routine

KW - selective

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85136212688&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/35072428

U2 - https://doi.org/10.1097/SLA.0000000000005228

DO - https://doi.org/10.1097/SLA.0000000000005228

M3 - Article

C2 - 35072428

SN - 0003-4932

VL - 277

SP - E578-E584

JO - Annals of surgery

JF - Annals of surgery

IS - 3

ER -

Bastiaenen VP, de Jonge J, Corten BJGA, de Savornin Lohman EAJ, Kraima AC, Swank HA et al. Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study. Annals of surgery. 2023 Mar 1;277(3):E578-E584. doi: https://doi.org/10.1097/SLA.0000000000005228

Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy: Results of the Multicenter, Prospective, Cross-Sectional FANCY Study

Abstract

Keywords

Access to Document

Other files and links

Cite this