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The Understated Malignancy Potential of Nonoperative Acute Appendicitis
The American Surgeon
|August 14, 2019
Summary
Appendiceal neoplasms (AN) are found in 1.2% of adults undergoing appendectomy for uncomplicated appendicitis (UA). Early surgical intervention for UA is crucial to prevent delayed diagnosis and progression of appendiceal neoplasms.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Epidemiology
Background:
- Appendiceal neoplasms (AN) are rare, often discovered incidentally after appendectomy for uncomplicated appendicitis (UA).
- The debate continues regarding non-surgical management versus appendectomy for UA.
Purpose of the Study:
- To establish current epidemiological data for adult patients who underwent appendectomy for UA with a secondary diagnosis of appendiceal neoplasm (AN).
Main Methods:
- The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2016) was queried.
- Adult patients undergoing appendectomy for UA with AN were identified and analyzed for perioperative data, including AN type, surgical procedure, and mortality.
Main Results:
- Out of 239,615 UA patients, 2,773 (1.2%) had AN.
- AN patients were predominantly white (79.5%), with a mean age of 54.5 years, and 54.6% were female.
- Malignant neoplasms constituted 64.5% of AN, followed by malignant carcinoid (17.3%), benign carcinoid (9.3%), and benign neoplasms (8.8%). The overall incidence was 1.2% with a 0.7% mortality rate.
Conclusions:
- Surgical intervention for adult UA cases reveals a 1% incidence of AN.
- Non-operative management with antibiotics alone for UA may delay diagnosis and treatment of AN, potentially worsening outcomes.
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