Risk Factors for Appendiceal Cancer After Appendectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Epidemiology

Background:

• Appendiceal cancer (AC) is a rare malignancy often incidentally discovered post-appendectomy.
• Risk factors associated with appendiceal cancer remain poorly understood.
• This study analyzes AC cases identified after appendectomy for acute appendicitis (AA).

Purpose of the Study:

• To conduct a descriptive analysis of patients with appendiceal cancer diagnosed after appendectomy for suspected acute appendicitis.
• To identify potential risk factors associated with appendiceal cancer in this patient population.

Main Methods:

• Utilized the 2016-2017 American College of Surgeons-National Surgical Quality Improvement Program Procedure-Targeted Appendectomy database.
• Compared adult patients undergoing appendectomy for suspected acute appendicitis, differentiating between those with confirmed appendicitis and those with appendiceal cancer.
• Employed multivariable logistic regression to analyze risk factors.

Main Results:

• Appendiceal cancer was found in 1.0% (203/21,058) of cases initially suspected as acute appendicitis.
• Patients with AC were older (median 48 vs. 40 years) compared to those with AA.
• Independent risk factors for AC included age ≥65 years (OR 2.25), absence of leukocytosis (OR 1.58), and operative time ≥1 hour (OR 1.57).

Conclusions:

• Appendiceal cancer is identified in approximately 1% of appendectomies performed for suspected acute appendicitis.
• Specific factors such as advanced age, lack of elevated white blood cell count, and prolonged operative duration may indicate a higher risk for appendiceal cancer.
• These identified factors can aid in risk stratification for appendiceal cancer in patients undergoing appendectomy.