Acute appendicitis in children with malignancy

To investigate the clinical characteristics and treatment outcomes of acute appendicitis in children with malignant tumors, with special attention to neutropenic status.

We retrospectively analyzed the clinical data of 31 children with malignant tumors who were diagnosed with acute appendicitis at the Beijing Children's Hospital from March 2007 to October 2023. Patients were grouped according to treatment modality (surgical vs. conservative management) and neutropenia status.

The median age was 5.2 (3.1, 8.8) years, and the male-to-female ratio was 4.2:1. The most common malignant tumor was acute lymphoblastic leukemia (22, 71%). The main clinical manifestations of acute appendicitis were abdominal pain (23, 74%) and fever (27, 87%). Neutropenia was present in 25 (81%) patients. Surgical treatment was initially chosen for 9 patients, and conservative management was chosen for 22 patients. The proportion of complicated appendicitis in the surgical group was significantly higher than that in the conservative management group (78% vs. 23%, p = 0.012). However, the absolute neutrophil count in the conservative management group was lower than that in the surgical group (0.06 × 10⁹/L vs. 0.35 × 10⁹/L, p = 0.006). There was no difference in the formation of intra-abdominal abscess or adhesive intestinal obstruction caused by appendicitis between the surgical and conservative management groups, or between the severe neutropenia and non-severe neutropenia groups. The length of hospital stay (5.0 (2.5, 7.5) days) for patients who underwent laparoscopic surgery was shorter than that for the conservative management group (9.0 (6.0, 12.5) days) (p = 0.037). All patients were cured of acute appendicitis, and there were no deaths.

Both surgical treatment and conservative management with broad-spectrum antibiotics are safe options for acute appendicitis in children with malignant tumors. However, due to significant selection bias in treatment allocation, our findings should be interpreted as descriptive rather than comparative. The observed shorter hospital stay in the laparoscopic appendectomy subgroup requires validation in prospective studies with appropriate adjustment for confounding factors. Treatment decisions should be individualized based on clinical presentation, neutropenia status, and multidisciplinary team assessment.