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Luca Stocchi, MD; Bruce G. Wolff, MD; Dirk R. Larson, MS; Jeff R. Harrington, MA

Arch Surg. 2003;138:585-590.

Hypothesis  Clinical presentation of appendiceal mucocele is related to malignancy and can influence surgical approach.

Design  Retrospective study.

Setting  Tertiary referral center.

Patients  All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) diagnosed between 1976 and 2000 were reviewed. There were 135 patients, 74 of whom were female. Mean age at diagnosis was 59 years. Mean follow-up was more than 6 years.

Interventions  A total of 129 patients underwent surgery, consisting of appendectomy (22 patients), right hemicolectomy (25 patients), or more extensive procedures (82 patients).

Main Outcome Measures  Clinical, diagnostic, and surgical variables were statistically compared with postoperative morbidity and mortality and the presence of malignancy. P<.05 was considered significant.

Results  The presence of symptoms was associated with malignancy (58% vs 15%, P<.001), particularly abdominal pain (56% vs 29%, P = .005) and weight loss (77% vs 31%, P = .002). Abdominal mass was also associated with malignancy (86% vs 25%, P<.001). Moreover, pseudomyxoma peritonei and mucocele extravasation were associated with malignancy (95% vs 13%, P<.001, and 83% vs 15%, P<.001, respectively). The lesion size was not associated with malignancy; however, cystadenomas were significantly larger than simple mucoceles (8.1 cm vs 4.1 cm, P<.001), and no cystadenoma was less than 2 cm in largest diameter.

Conclusions  A number of clinical, diagnostic, and intraoperative findings are associated with malignant mucoceles. All mucoceles greater than 2 cm should be excised to remove premalignant lesions.

From the Division of Colon and Rectal Surgery (Drs Wolff and Larson), Department of Surgery (Dr Stocchi), and the Department of Biostatistics (Mr Harrington), Mayo Clinic, Rochester, Minn.

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