PM12 - Quality Analysis of Operative Reports and Referral Data for Appendiceal Peritoneal Carcinomatosis

Background: Peritoneal carcinomatosis from appendiceal neoplasms is a rare disease usually found unexpectedly at the time of appendectomy. Most practicing surgeons may never, or will rarely encounter this in their career. Thus, quality reporting of key clinical information to specialty referral centers is often suboptimal.

Methods: Retrospective review of our appendiceal peritoneal carcinomatosis database evaluating index operative and pathology reports. Quality was scored for the operative report by two standards. General quality of the operative report determined by the Royal College of Surgeons “Good Practice Guidelines”. Specific peritoneal carcinomatosis standard determined by thoroughness of peritoneal evaluation and reporting of disease.

Results: 857 cases over a 26 year period were reviewed. General quality of the index operative reports was excellent with nearly 90% of reports encompassing all the RCS quality metrics. However, the assessments of peritoneal metastasis/carcinomatosis quality was uniformly poor. 48% of the reports limited description of evaluation only to the appendix itself, while 38% only involved partial peritoneal evaluation. Only 14% of all the reports described a complete peritoneal evaluation. 44% of the pathology reports from the referring institution had discrepancies with final pathologic findings. Of the discordant pathology reports, 30% misdiagnosed low-grade and 70% misdiagnosed high-grade.

Conclusions: This review finds that referral operative reports description of the technical procedure is usually complete. However, oncologic parameters and descriptions of peritoneal metastases is frequently lacking. Further, pathology reports from outside institutions are frequently misleading. We propose a structured peritoneal evaluation to assist with accurate reporting of burden of disease.