Skip to main content

Risk factors for appendiceal neoplasm and malignancy among patients with acute appendicitis

International Journal of Colorectal Disease volume 35, pages 157–163 (2020)Cite this article

Abstract

Purpose

Non-operative management of acute uncomplicated appendicitis has shown promising results but might carry the risk of delayed diagnosis of premalignant or malignant appendiceal tumors found by chance in 0.7–2.5% of appendiceal specimen after appendectomy. Purpose of this study was to analyze whether appendiceal tumors are associated with a complicated appendicitis and to determine risk factors for appendiceal neoplasm and malignancy in patients with acute appendicitis.

Methods

We performed a retrospective analysis of 1033 adult patients, who underwent appendectomy for acute appendicitis from 2010 to 2016 at the University hospital Erlangen. Data included patients’ demographics; comorbidities; pre-, intra- and postoperative findings; and histopathological results. Complicated appendicitis was defined in the presence of perforation or abscess.

Results

Appendiceal neoplasm respectively malignancy rate was 2.8% respectively 1.5%. Using univariate analysis, we identified seven risk factors at least for appendiceal neoplasm or malignancy: age, ASA, C-reactive protein, appendiceal diameter, perforation, intraoperative perithyphilitic abscess, and complicated appendicitis. Risk for appendiceal neoplasm or malignancy was 4.4% respectively 2.7% in complicated acute appendicitis compared to 2.0% respectively 1.0% in uncomplicated appendicitis (p = 0.043 respectively p = 0.060). In multivariate analysis, age ≥ 50 years and a diameter of the appendix in the sonography ≥ 13 mm were independent risk factors predicting the presence of appendiceal neoplasm and malignancy.

Conclusion

Among patients with appendicitis, there are relevant risk factors predicting appendiceal tumors, especially age and appendiceal diameter in sonography. But the identified risk factors have a low sensitivity and specificity, so obtaining a confident preoperative diagnosis is challenging.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Stewart B, Khanduri P, McCord C et al (2014) Global disease burden of conditions requiring emergency surgery. Br J Surg 101:9–22

    Article  Google Scholar 

  2. Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–348

    CAS  Article  Google Scholar 

  3. Wilms IM, de Hoog DE, de Visser DC, Janzing HM (2011) Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane DatabaseSyst Rev 11:CD008359.

  4. Varadhan KK, Neal KR, Lobo DN (2012) Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 344:e2156

    Article  Google Scholar 

  5. Hansson J, Korner U, Khorram-Manesh A, Solberg A, Lundholm K (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96:473–481

    CAS  Article  Google Scholar 

  6. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, Parina R, Salazar FR, Talamini MA (2014) Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg 218(5):905–913

    Article  Google Scholar 

  7. Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, Karoui M, Alves A, Dousset B, Valleur P, Falissard B, Franco D (2011) Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 377(9777):1573–1579

    CAS  Article  Google Scholar 

  8. Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Grönroos JM (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348

    CAS  Article  Google Scholar 

  9. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 386(10000):1278–1287

    Article  Google Scholar 

  10. Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS (2014) Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Color Dis 29(8):1009–1012

    Article  Google Scholar 

  11. Marudanayagam R, Williams GT, Rees BI (2006) Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol 41(8):745–749

    Article  Google Scholar 

  12. Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 41(1):75–80

    CAS  Article  Google Scholar 

  13. Loftus TJ, Raymond SL, Sarosi GA Jr, Croft CA, Smith RS, Efron PA, Moore FA, Brakenridge SC, Mohr AM, Jordan JR (2017) Predicting appendiceal tumors among patients with appendicitis. J Trauma Acute Care Surg 82(4):771–775

    Article  Google Scholar 

  14. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH (2015) Is there truly an oncologic indication for interval appendectomy? Am J Surg 209(3):442–446

    Article  Google Scholar 

  15. FurmanMJ CM, Cohen P, Lambert LA (2013) Increased risk of mucinous neoplasm of the appendix in adults undergoing interval appendectomy. JAMA Surg 148(8):703–706

    Article  Google Scholar 

  16. Carpenter SG, Chapital AB, Merritt MV, Johnson DJ (2012) Increased risk of neoplasm in appendicitis treated with interval appendectomy: single-institution experience and literature review. Am Surg 78(3):339–343

    PubMed  Google Scholar 

  17. Benedix F, Reimer A, Gastinger I, Mroczkowski P, Lippert H, Kube R, Study Group Colon/Rectum Carcinoma Primary Tumor (2010) Primary appendiceal carcinoma--epidemiology, surgery and survival: results of a German multi-center study. Eur J Surg Oncol 36(8):763–771

    CAS  Article  Google Scholar 

  18. Lietzén E, Grönroos JM, Mecklin JP, Leppäniemi A, Nordström P, Rautio T, Rantanen T, Sand J, Paajanen H, Kaljonen A, Salminen P (2019) Appendiceal neoplasm risk associated with complicated acute appendicitis-a population based study. Int J Color Dis 34(1):39–46

    Article  Google Scholar 

  19. Sadot E, Keidar A, Shapiro R, Wasserberg N (2013) Laparoscopic accuracy in prediction of appendiceal pathology: oncologic and inflammatory aspects. Am J Surg 206(5):805–809

    Article  Google Scholar 

  20. West NE, Wise PE, Herline AJ, Muldoon RL, Chopp WV, Schwartz DA (2007) Carcinoid tumors are 15 times more common in patients with Crohn’s disease. Inflamm Bowel Dis 13(9):1129–1134

    CAS  Article  Google Scholar 

  21. Todd RD, Sarosi GA, Nwariaku F, Anthony T (2004) Incidence and predictors of appendiceal tumors in elderly males presenting with signs and symptoms of acute appendicitis. Am J Surg 188(5):500–504

    Article  Google Scholar 

  22. Reich B, Zalut T, Weiner SG (2011) An international evaluation of ultrasound vs. computed tomography in the diagnosis of appendicitis. Int J Emerg Med 4:68

Download references

Acknowledgments

The present work was performed in partial fulfillment of the requirements for obtaining the degree “Dr. med” for P. Lapins.

Author information

Affiliations

  1. Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany

    Maximilian Brunner, Philipp Lapins, Melanie Langheinrich, Justus Baecker, Christian Krautz, Stephan Kersting, Georg F. Weber, Robert Grützmann & Matthias Maak

Authors
  1. Maximilian Brunner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Lapins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melanie Langheinrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Justus Baecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Krautz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephan Kersting
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georg F. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert Grützmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Matthias Maak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maximilian Brunner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

For this type of study formal consent is not required.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This study contains no information that would enable individual patient identity.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brunner, M., Lapins, P., Langheinrich, M. et al. Risk factors for appendiceal neoplasm and malignancy among patients with acute appendicitis. Int J Colorectal Dis 35, 157–163 (2020). https://doi.org/10.1007/s00384-019-03453-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03453-5

Keywords

  • Complicated appendicitis
  • Appendectomy
  • Appendiceal neoplasm
  • Malignancy
  • Risk factors