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Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study

International Journal of Colorectal Disease volume 34, pages 39–46 (2019)Cite this article

Abstract

Purpose

Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis.

Methods

This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals.

Results

Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n = 250), and out of these, 41% (n = 102) were complicated and 59% (n = 148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p < 0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%.

Conclusions

Appendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.

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Fig. 1

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Funding

This study was supported by a Turku University Hospital Government Research Grant (TYKS EVO Foundation), Paulo Foundation, and Constitution of The Gastroenterological Research Foundation.

Author information

Affiliations

  1. Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520, Turku, Finland

    Elina Lietzén, Juha M. Grönroos & Paulina Salminen

  2. University of Turku, Turku, Finland

    Elina Lietzén, Juha M. Grönroos & Paulina Salminen

  3. Department of Surgery, Jyväskylä Central Hospital and Sport and Health Sciences, Jyväskylä, Finland

    Jukka-Pekka Mecklin

  4. University of Jyväskylä, Jyväskylä, Finland

    Jukka-Pekka Mecklin

  5. Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland

    Ari Leppäniemi

  6. University of Helsinki, Helsinki, Finland

    Ari Leppäniemi

  7. Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland

    Pia Nordström

  8. University of Tampere, Tampere, Finland

    Pia Nordström

  9. Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland

    Tero Rautio

  10. University of Oulu, Oulu, Finland

    Tero Rautio

  11. Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland

    Tuomo Rantanen

  12. Department of Surgery, Kuopio University Hospital, Kuopio, Finland

    Tuomo Rantanen

  13. University of Kuopio, Kuopio, Finland

    Tuomo Rantanen

  14. Health and Medical Services, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland

    Juhani Sand

  15. Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland

    Hannu Paajanen

  16. The Department of Biostatistics, University of Turku, Turku, Finland

    Anne Kaljonen

Authors
  1. Elina Lietzén
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  2. Juha M. Grönroos
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  4. Ari Leppäniemi
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  5. Pia Nordström
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  6. Tero Rautio
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  7. Tuomo Rantanen
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  8. Juhani Sand
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  9. Hannu Paajanen
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  10. Anne Kaljonen
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  11. Paulina Salminen
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Corresponding author

Correspondence to Elina Lietzén.

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Conflict of interest

Dr. Salminen has received personal fees for lectures from Merck, Lilly, and Orion Pharma.

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Cite this article

Lietzén, E., Grönroos, J.M., Mecklin, JP. et al. Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study. Int J Colorectal Dis 34, 39–46 (2019). https://doi.org/10.1007/s00384-018-3156-x

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  • DOI: https://doi.org/10.1007/s00384-018-3156-x

Keywords

  • Acute appendicitis
  • Uncomplicated acute appendicitis
  • Complicated acute appendicitis
  • Non-operative treatment
  • Appendectomy
  • Appendiceal neoplasm