South Coast appendicular mass management (SCAM) survey

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• The management of appendicular mass and the role of interval appendectomy remain debated.
• A recent randomized controlled trial (RCT) was terminated due to a high incidence of neoplastic lesions in older patients managed with magnetic resonance imaging (MRI) surveillance alone.

Purpose of the Study:

• To evaluate current practices in managing appendicular mass across five major hospitals in South Coast England.

Main Methods:

• A proforma was distributed to general surgical departments in five South Coast hospitals.
• Data collection was enhanced through direct telephone calls to on-call registrars and consultants.

Main Results:

• Fifty-three surgeons participated, with consensus on initial management involving clinical, hematological, and CT criteria, IV antibiotics, and radiological drainage for appendicular mass/abscess.
• Discharge indicators included normalized inflammatory markers and radiological resolution. Follow-up investigations varied, with 57% opting for both CT and colonoscopy.
• Only 17% of surgeons routinely offered planned interval appendectomy, while 62% offered it selectively within 6 months.

Conclusions:

• The South Coast Appendicular Mass (SCAM) survey reveals diverse surgical practices for appendicular mass/abscess management.
• A significant proportion of surgeons do not offer interval appendectomy, potentially delaying the diagnosis and treatment of underlying neoplastic lesions.