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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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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References

  1. Salminen P, Paajanen H, Rautio T, Nordstrom P, Aarnio M, Rantanen T et al (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348

    Article  CAS  PubMed  Google Scholar 

  2. Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO, Agoritsas T, Heels-Ansdell D, Guyatt GH, Tikkinen KAO (2016) Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg 103(6):656–667

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 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

    Article  CAS  PubMed  Google Scholar 

  4. Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH (2017) Systematic review and meta-analysis of CT features for differentiating complicated and uncomplicated appendicitis. Radiology 171260

  5. Park HC, Kim MJ, Lee BH (2017) Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis. Br J Surg 104(13):1785–1790

    Article  CAS  PubMed  Google Scholar 

  6. Sippola S, Gronroos J, Tuominen R, Paajanen H, Rautio T, Nordstrom P et al (2017) Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial. Br J Surg 104(10):1355–1361

    Article  CAS  PubMed  Google Scholar 

  7. Andersson RE, Petzold MG (2007) Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 246(5):741–748

    Article  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

  9. 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(8):703–706

    Article  PubMed  Google Scholar 

  10. 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 

  11. Murphy EM, Farquharson SM, Moran BJ (2006) Management of an unexpected appendiceal neoplasm. Br J Surg 93(7):783–792

    Article  CAS  PubMed  Google Scholar 

  12. Teixeira FJR Jr, Couto Netto SDD, 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 12:12

    Article  PubMed  PubMed Central  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  PubMed  PubMed Central  Google Scholar 

  14. Whitley S, Sookur P, McLean A, Power N (2009) The appendix on CT. Clin Radiol 64(2):190–199

    Article  CAS  PubMed  Google Scholar 

  15. Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI (2002) Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison. Radiology 224(3):775–781

    Article  PubMed  Google Scholar 

  16. Shaib W, Krishna K, Kim S, Goodman M, Rock J, Chen Z, Brutcher E, Staley CIII, Maithel SK, Abdel-Missih S, el-Rayes BF, Bekaii-Saab T (2016) Appendiceal neuroendocrine, goblet and signet-ring cell tumors: a spectrum of diseases with different patterns of presentation and outcome. Cancer Res Treat 48(2):596–604

    Article  PubMed  Google Scholar 

  17. Hsu C, Rashid A, Xing Y, Chiang YJ, Chagpar RB, Fournier KF, Chang GJ, You YN, Feig BW, Cormier JN (2013) Varying malignant potential of appendiceal neuroendocrine tumors: importance of histologic subtype. J Surg Oncol 107(2):136–143

    Article  PubMed  Google Scholar 

  18. Brathwaite S, Yearsley MM, Bekaii-Saab T, Wei L, Schmidt CR, Dillhoff ME et al (2016) Appendiceal mixed adeno-neuroendocrine carcinoma: a population-based study of the surveillance, epidemiology, and end results registry. Front Oncol 6:148

    Article  PubMed  PubMed Central  Google Scholar 

  19. McGory ML, Maggard MA, Kang H, O'Connell JB, Ko CY (2005) Malignancies of the appendix: beyond case series reports. Dis Colon Rectum 48(12):2264–2271

    Article  PubMed  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. McCusker ME, Cote TR, Clegg LX, Sobin LH (2002) Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998. Cancer 94(12):3307–3312

    Article  PubMed  Google Scholar 

  22. Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA (2008) Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol 34(2):196–201

    Article  CAS  PubMed  Google Scholar 

  23. Maggard MA, O'Connell JB, Ko CY (2004) Updated population-based review of carcinoid tumors. Ann Surg 240(1):117–122

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mullen JT, Savarese DM (2011) Carcinoid tumors of the appendix: a population-based study. J Surg Oncol 104(1):41–44

    Article  PubMed  Google Scholar 

  25. Marmor S, Portschy PR, Tuttle TM, Virnig BA (2015) The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg 19(4):743–750

    Article  PubMed  Google Scholar 

  26. van den Heuvel MG, Lemmens VE, Verhoeven RH, de Hingh IH (2013) The incidence of mucinous appendiceal malignancies: a population-based study. Int J Color Dis 28(9):1307–1310

    Article  Google Scholar 

  27. Shaib WL, Goodman M, Chen Z, Kim S, Brutcher E, Bekaii-Saab T, et al. (2015) Incidence and survival of appendiceal mucinous neoplasms: a SEER analysis. Am J Clin Oncol

  28. Pape UF, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O''Connor J, Krenning E, Reed N, O''Toole D, all other Vienna Consensus Conference participants (2016) ENETS consensus guidelines for neuroendocrine neoplasms of the appendix (excluding goblet cell carcinomas). Neuroendocrinology 103(2):144–152

    Article  CAS  PubMed  Google Scholar 

  29. Tchana-Sato V, Detry O, Polus M, Thiry A, Detroz B, Maweja S, Hamoir E, Defechereux T, Coimbra C, de Roover A, Meurisse M, Honoré P (2006) Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol 12(41):6699–6701

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee WS, 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 Color Dis 26(5):617–621

    Article  Google Scholar 

  31. 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 

  32. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP (2010) A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 147(6):818–829

    Article  PubMed  Google Scholar 

  33. Livingston EH, Fomby TB, Woodward WA, Haley RW (2011) Epidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis. Arch Surg 146(3):308–314

    Article  PubMed  Google Scholar 

  34. Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K (2012) Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice. World J Surg 36(9):2028–2036

    Article  PubMed  Google Scholar 

  35. Lietzen E, Mallinen J, Gronroos JM, Rautio T, Paajanen H, Nordstrom P et al (2016) Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging? Surgery 160(3):789–795

    Article  PubMed  Google Scholar 

  36. Sagebiel TL, Mohamed A, Matamoros A, Taggart MW, Doamekpor F, Raghav KP, Mann GN, Mansfield PF, Eng C, Royal RE, Foo WC, Ensor JE, Fournier KF, Overman MJ (2017) Utility of appendiceal calcifications detected on computed tomography as a predictor for an underlying appendiceal epithelial neoplasm. Ann Surg Oncol 24(12):3667–3672

    Article  PubMed  Google Scholar 

  37. Bennett GL, Tanpitukpongse TP, Macari M, Cho KC, Babb JS (2009) CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol 192(3):W103–W110

    Article  PubMed  Google Scholar 

  38. Hines JJ, Paek GK, Lee P, Wu L, Katz DS (2016) Beyond appendicitis; radiologic review of unusual and rare pathology of the appendix. Abdom Radiol (NY) 41(3):568–581

    Article  Google Scholar 

  39. Turaga KK, Pappas SG, Gamblin T (2012) Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol 19(5):1379–1385

    Article  PubMed  Google Scholar 

Download references

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

Authors and 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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  3. Jukka-Pekka Mecklin
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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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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

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