Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age

John P Skendelas,Victor S Alemany,Peter K Kim,Vincent Au,John Mcnelis,Devika Rao

doi:10.1186/s12893-021-01224-0

Abstract

BackgroundAppendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies.MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed.ResultsWe found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years.ConclusionsAppendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.

Highlights

Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States
Antibiotic therapy has been used in 40–45% of patients in Europe compared to fewer than 5% in the United States [8, 9]; Skendelas et al BMC Surg (2021) 21:228 this approach has been challenged due to the ongoing “Comparison of Drugs versus Appendectomy” (CODA) trial, which found that early outcomes of medical management of appendicitis, with or without appendicolith, was non-inferior to surgery [10]
The combined incidence of appendiceal neoplasms identified in these data are 0.4%, 0.8%, 1.6%, 2.1%, and 1.6% respectively for age 40–49, 50–59, 60–69, 70–79, and > 80

Summary

Introduction

Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. Antibiotic therapy has been used in 40–45% of patients in Europe compared to fewer than 5% in the United States [8, 9]; Skendelas et al BMC Surg (2021) 21:228 this approach has been challenged due to the ongoing “Comparison of Drugs versus Appendectomy” (CODA) trial, which found that early outcomes of medical management of appendicitis, with or without appendicolith, was non-inferior to surgery [10]. Unintended consequences of nonoperative management may include increased incidence of antibiotic-resistant organisms and alterations to the microbiome [3]. This approach has been adopted by the American College of Surgeons during the current pandemic and will likely continue [13]

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Discussion

Conclusion