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Is interval appendectomy really needed? A closer look at neoplasm rates in adult patients undergoing interval appendectomy after complicated appendicitis

Surgical Endoscopy volume 35, pages 3855–3860 (2021)Cite this article

Abstract

Background

The treatment algorithm for appendicitis is evolving, with recent interest in non-operative management. However, the safety of non-operative management for patients with complicated appendicitis has been questioned due to concern for increased risk of occult appendiceal neoplasm in this patient population. Our study aims to determine the rate of neoplasms discovered during interval appendectomy for patients with complicated appendicitis and determine the necessity of interval appendectomy.

Methods

A retrospective chart review was conducted on interval appendectomies performed in adult patients for complicated appendicitis at our institution over a 9-year period. Interval appendectomy was defined as appendectomy delayed from initial presentation with appendicitis. Complicated appendicitis was defined as perforation, phlegmon, and/or abscess as seen on computed tomography at time of presentation.

Results

We identified 402 patients who underwent interval appendectomy for complicated appendicitis. A total of 36 appendiceal neoplasms were discovered on final pathology with an overall neoplasm rate of 9%. Patients with an appendiceal neoplasm were significantly older (56.6 years vs 45.1 years, p < 0.01). No patients under the age of 30 had a neoplasm. The rate of appendiceal neoplasms in patients 30 years and older was 11%. The rate for patients 50 years and older was 16%. For patients 80 years and older, the rate of appendiceal neoplasm was 43%.

Conclusion

The risk of occult appendiceal neoplasm is low in patients under the age of 30; however, there was an 11% rate of appendiceal neoplasm in patients 30 years and older. The risk increases with increased age, with a 16% risk in patients 50 years and older. Given these findings, we recommend consideration of interval appendectomy in all patients 30 years and older with complicated appendicitis.

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References

  1. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, Bhala N, Ghosh S, Dixon E, Ng S, Kaplan GG (2017) The global incidence of appendicitis. Ann Surg 266:237–241. https://doi.org/10.1097/sla.0000000000002188

    Article  PubMed  Google Scholar 

  2. Drake FT, Mottey NE, Farrokhi ET, Florence MG, Johnson MG, Mock C, Steele SR, Thirlby RC, Flum DR (2014) Time to appendectomy and risk of perforation in acute appendicitis. JAMA Surg 149:837. https://doi.org/10.1001/jamasurg.2014.77

    Article  PubMed  PubMed Central  Google Scholar 

  3. Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317. https://doi.org/10.1007/s002689900235

    Article  PubMed  Google Scholar 

  4. Garst GC, Moore EE, Banerjee MN et al (2013) Acute appendicitis. J Trauma Acute Care Surg 74:32–36

    Article  Google Scholar 

  5. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH (2015) Is there truly an oncologic indication for interval appendectomy? Am J Surg 209:442–446. https://doi.org/10.1016/j.amjsurg.2014.09.020

    Article  PubMed  Google Scholar 

  6. Wagner M, Tubre DJ, Asensio JA (2018) Evolution and current trends in the management of acute appendicitis. Surg Clin North Am 98:1005–1023. https://doi.org/10.1016/j.suc.2018.05.006

    Article  PubMed  Google Scholar 

  7. Tekin A, Kurtoğlu HC, Can I, Öztan S (2008) Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass. Colorectal Dis 10:465–468. https://doi.org/10.1111/j.1463-1318.2007.01377.x

    CAS  Article  PubMed  Google Scholar 

  8. Kaminski A (2005) Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg 140:897. https://doi.org/10.1001/archsurg.140.9.897

    Article  PubMed  Google Scholar 

  9. Lai H-W, Loong C-C, Chiu J-H, Chau G-Y, Wu C-W, Lui W-Y (2006) Interval appendectomy after conservative treatment of an appendiceal mass. World J Surg 30:352–357. https://doi.org/10.1007/s00268-005-0128-4

    Article  PubMed  Google Scholar 

  10. Willemsen PJ, Hoorntje LE, Eddes E-H, Ploeg RJ (2002) The need for interval appendectomy after resolution of an appendiceal mass questioned. Digest Surg 19:216–222. https://doi.org/10.1159/000064216

    Article  Google Scholar 

  11. Teixeira FJR, Netto SDDC, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC (2017) Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg. https://doi.org/10.1186/s13017-017-0122-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. Smeenk R, Velthuysen MV, Verwaal V, Zoetmulder F (2008) Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol (EJSO) 34:196–201. https://doi.org/10.1016/j.ejso.2007.04.002

    CAS  Article  Google Scholar 

  14. Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors. Dis Colon Rectum 41:75–80. https://doi.org/10.1007/bf02236899

    CAS  Article  PubMed  Google Scholar 

  15. Deakin D, Ahmed I (2007) Interval appendicectomy after resolution of adult inflammatory appendix mass—is it necessary? The Surgeon 5:45–50. https://doi.org/10.1016/s1479-666x(07)80111-9

    CAS  Article  PubMed  Google Scholar 

  16. Tannoury J (2013) Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 19:3942. https://doi.org/10.3748/wjg.v19.i25.3942

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kumar S, Jain S (2004) Treatment of appendiceal mass: prospective randomized clinical trial. Indian J Gastroenterol 23:165–167

    PubMed  Google Scholar 

  18. Youssef T, Badrawy A (2010) Prospective evaluation of the necessity of interval appendectomy after resolution of appendiceal mass. Egypt J Sur 29:85–89

    Google Scholar 

  19. Mällinen J, Rautio T, Grönroos J, Rantanen T, Nordström P, Savolainen H, Ohtonen P, Hurme S, Salminen P (2019) Risk of appendiceal neoplasm in periappendicular abscess in patients treated with interval appendectomy vs follow-up with magnetic resonance imaging. JAMA Surg 154:200. https://doi.org/10.1001/jamasurg.2018.4373

    Article  PubMed  Google Scholar 

  20. Furman MJ, Cahan M, Cohen P, Lambert LA (2013) Increased risk of mucinous neoplasm of the appendix in adults undergoing interval appendectomy. JAMA Surg 148:703. https://doi.org/10.1001/jamasurg.2013.1212

    Article  PubMed  Google Scholar 

  21. Lee W-S, Choi ST, Lee JN, Kim KK, Park YH, Baek JH (2011) A retrospective clinicopathological analysis of appendiceal tumors from 3,744 appendectomies: a single-institution study. Int J Colorectal Dis 26:617–621. https://doi.org/10.1007/s00384-010-1124-1

    Article  PubMed  Google Scholar 

  22. Deelder JD, Richir MC, Schoorl T, Schreurs WH (2014) How to treat an appendiceal inflammatory mass: operatively or nonoperatively? J Gastrointest Surg 18:641–645. https://doi.org/10.1007/s11605-014-2460-1

    CAS  Article  PubMed  Google Scholar 

  23. Kim JY, Kim JW, Park JH, Kim BC, Yoon SN (2019) Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study. Ann Surg Treat Res 97(2):103–111. https://doi.org/10.4174/astr.2019.97.2.103

    Article  PubMed  PubMed Central  Google Scholar 

  24. Smink, D, Soybel, DI (2020) Management of acute appendicitis in adults. In: Weiser M, Chen W (ed) UpToDate. Waltham, Mass.: UpToDate, 2020. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults. Accessed April 2, 2020.

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Disclosures

Drs. Danielle Hayes, Shelby Reiter, MD, Gary Lucas, MD, Edward Hagen MD, Isabelle Chu MD, Tobias Muñiz MD1, and Ryan Martinez, MD have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Surgery, Swedish Medical Center, Seattle, WA, USA

    Danielle Hayes, Shelby Reiter, Edard Hagen, Gary Lucas, Isabelle Chu, Tobias Muñiz & Ryan Martinez

  2. General Surgery Residency, Swedish Medical Center, 747 Broadway, Heath 10, Seattle, WA, 98122, USA

    Shelby Reiter

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  1. Danielle Hayes
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  2. Shelby Reiter
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Correspondence to Shelby Reiter.

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Hayes, D., Reiter, S., Hagen, E. et al. Is interval appendectomy really needed? A closer look at neoplasm rates in adult patients undergoing interval appendectomy after complicated appendicitis. Surg Endosc 35, 3855–3860 (2021). https://doi.org/10.1007/s00464-020-07798-9

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Keywords

  • Interval appendectomy
  • Complicated appendicitis
  • Appendicitis
  • Phlegmon
  • Appendiceal neoplasm
  • Appendiceal mass
  • Appendiceal abscess