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Bendib H. Is non-operative treatment of acute appendicitis possible: A narrative review. Afr J Emerg Med 2024; 14:84-90. [PMID: 38617036 PMCID: PMC11010839 DOI: 10.1016/j.afjem.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Acute appendicitis (AA) represents the most frequent surgical emergency. Perforation was long considered the ultimate outcome of AA, prompting appendectomy; which remains the standard treatment. New data have clarified the role of the appendix, justifying conservative treatment. This narrative review aims to summarize the evidence regarding the non-operative treatment (NOT) of AA in adults. Methods The literature search was performed via the PubMed Medline database. Our criteria-based selection resulted in a total of 48 articles for review. Results Recent trials and meta-analyses have assessed NOT, which support primary antibiotic treatment of uncomplicated AA. Although it has a significant recurrence and failure rate, NOT does not appear to increase the risk of appendicular perforation. Moreover, NOT compared with appendectomy, seems to be associated with less morbidity, lower cost of care and preserved quality of life. Conclusion First-line NOT seems to be a reasonable approach for the treatment of uncomplicated CT-confirmed AA. Careful patient screening would definitely enhance the success rate.
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Affiliation(s)
- Hani Bendib
- Department of General Surgery, EPH Kouba, Algiers, Algeria
- Faculty of Medicine, Algiers 1 University, Algeria
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2
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Saeed A, Abuzaid Y, Hammad M. Prevalence of, Subtypes of, and the Role of Age in Incidental Appendiceal Neoplasms in Acute Appendicitis: A Single-Institute Study from Bahrain. Cureus 2024; 16:e60150. [PMID: 38864054 PMCID: PMC11166375 DOI: 10.7759/cureus.60150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Primary appendiceal neoplasms (ANs) are rare entities that can present with acute appendicitis symptoms. Accurate diagnosis of these diverse subtypes is crucial for prognosis and proper management. AIMS AND OBJECTIVES This descriptive retrospective study aims to determine the prevalence and pathological subtypes of incidental ANs in patients presenting with acute appendicitis symptoms at Salmaniya Medical Center (SMC) in Bahrain between the period of January 2020 and March 2024. Particular focus was placed on investigating whether advanced age is a significant risk factor for these neoplasms. MATERIALS AND METHODS The study included 38,643 patients (aged 15 years and above) who underwent appendectomy for suspected acute appendicitis during the study period. Demographic data, clinical diagnoses, preoperative imaging findings, histopathological reports, and management details were analyzed. Medical records of patients were retrieved from ISEHA system. Statistical analysis was done using Microsoft Excel. RESULTS The results showed that 12 patients (0.04% per year) had different subtypes of appendiceal tumors. Neuroendocrine tumors were the most common, identified in nine patients (75%), including nine cases of well-differentiated neuroendocrine carcinoma (NEC). Other histopathological subtypes included low-grade appendiceal mucinous neoplasm (LAMN), adenocarcinoma, and goblet cell adenocarcinoma, each found in one patient. Additionally, two patients had confirmed appendiceal mucocele. The mean age of patients with ANs was 30 years (range: 19-52 years), and 66.6% were younger than 38 years. Conclusion: These findings highlight the importance of considering ANs in the differential diagnosis of acute appendicitis, especially in older patients. Further research is warranted to confirm the role of age as a risk factor and guide clinical decision-making.
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Affiliation(s)
- Ahmed Saeed
- Surgery, Salmaniya Medical Complex, Manama, BHR
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Gal M, Maya P, Ofer K, Mansoor K, Benyamine A, Boris K. Acute Appendicitis in the Elderly: A Nationwide Retrospective Analysis. J Clin Med 2024; 13:2139. [PMID: 38610904 PMCID: PMC11012554 DOI: 10.3390/jcm13072139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years. Results: Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (p < 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (p < 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group. Conclusions: This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups.
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Affiliation(s)
- Malkiely Gal
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Paran Maya
- Department of Pediatric and Adolescent Surgery, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
| | - Kobo Ofer
- Division of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Khan Mansoor
- Department of Major Trauma, Hull University Teaching Hospitals, Hull HU3 2JZ, UK
| | - Abbou Benyamine
- Hospital Administration Hillel Yaffe Medical Center, Hadera 38100, Israel;
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Kessel Boris
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
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4
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Fransvea P, Puccioni C, Altieri G, D'Agostino L, Costa G, Tropeano G, La Greca A, Brisinda G, Sganga G. Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy. Langenbecks Arch Surg 2024; 409:87. [PMID: 38441707 DOI: 10.1007/s00423-024-03277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy. MATERIAL AND METHODS Single-centre retrospective cohort analysis of patients treated for acute appendicitis at a large academic medical centre. Patients with a diagnosis of acute appendicitis (AA) where further compared with patients with acute appendicitis and a histologically confirmed diagnosis of appendiceal neoplasm (AN). RESULTS A diagnosis of acute appendicitis was made in 1200 patients. Of these, 989 patients underwent emergency appendectomy. The overall incidence of appendiceal neoplasm was 9.3% (92 patients). AN rate increased with increasing age. Patients under the age of 30 had a 3.8% (14/367 patients) rate of occult neoplasm, whereas patients between 40 and 89 years and older had a 13.0% rate of neoplasm. No difference was found in clinical presentations and type of approach while we found a lower complicated appendicitis rate in the AN group. CONCLUSION ANs are less rare with respect to the literature; however, clinically, there are no specific signs of suspicious and simple appendicectomy appears to be curative in most cases. However, age plays an important role; older patients are at higher risk for AN. ANs still challenge the non-operative management concept introduced into the surgical literature.
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Affiliation(s)
- Pietro Fransvea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy.
- Università Cattolica del Sacro Cuore Roma Italia, Rome, Italy.
| | - Caterina Puccioni
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
- Università Cattolica del Sacro Cuore Roma Italia, Rome, Italy
| | - Gaia Altieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
| | - Luca D'Agostino
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
| | - Gianluca Costa
- Surgery Center, Colorectal Surgery Clinical and Research Unit - Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giuseppe Tropeano
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
| | - Antonio La Greca
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
- Università Cattolica del Sacro Cuore Roma Italia, Rome, Italy
| | - Giuseppe Brisinda
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
- Università Cattolica del Sacro Cuore Roma Italia, Rome, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
- Università Cattolica del Sacro Cuore Roma Italia, Rome, Italy
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5
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Ramadan S, Buchwald P, Olsson Å. Risk of appendiceal malignancy in conservatively treated acute appendicitis. Scand J Surg 2023; 112:227-234. [PMID: 37705259 DOI: 10.1177/14574969231190293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND AIMS Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis. METHODS This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts. RESULTS The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002). CONCLUSION The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.
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Affiliation(s)
- Shaima Ramadan
- Colorectal Unit
- Department of Surgery Skåne University Hospital SE-205 02 Malmö Sweden
- Department of Clinical Sciences, Malmö Lund University Malmö Sweden
| | - Pamela Buchwald
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Åsa Olsson
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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Jolly S, McCullough T, Gunning T, Maddern G, Wichmann M. Incidence of occult appendiceal neoplasm in patients over 40 years with acute appendicitis: A single-institution review. Aust J Rural Health 2023; 31:1261-1265. [PMID: 37876354 DOI: 10.1111/ajr.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. METHODS The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. DESIGN Retrospective cohort study. SETTING Modified Monash category 3 (large rural town). PARTICIPANTS Patients aged 40 years and over undergoing appendicectomy for appendicitis. MAIN OUTCOME MEASURES Incidence of appendiceal neoplasm within appendicectomy specimen. RESULTS A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40-95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic-type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. CONCLUSIONS Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic.
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Affiliation(s)
- Samantha Jolly
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Timothy McCullough
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Thomas Gunning
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Guy Maddern
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Matthias Wichmann
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
- Flinders University Rural Health South Australia, Flinders University, Adelaide, South Australia, Australia
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Solis-Pazmino P, Oka K, La K, Termeie O, Figueroa LA, Pilatuna E, Solis-Pazmino D, Harnegie MP, Cohen J, Barnajian M, Nasseri Y. Incidence rate and histology of appendiceal neoplasms in complicated versus uncomplicated appendicitis: A meta-analysis and systematic review. Langenbecks Arch Surg 2023; 408:432. [PMID: 37940770 PMCID: PMC10632310 DOI: 10.1007/s00423-023-03164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Studies evaluating the rate and histology of appendiceal neoplasms between complicated and uncomplicated appendicitis include a small number of patients. Therefore, we sought a meta-analysis and systematic review comparing the rates and types of appendiceal neoplasm between complicated and uncomplicated appendicitis. METHODS We included articles published from the time of inception of the datasets to September 30, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. RESULTS A total of 4962 patients with appendicitis enrolled in 4 comparative studies were included. The mean age was 43.55 years (16- 94), and half were male (51%). Based on intra-operative findings, 1394 (38%) had complicated appendicitis, and 3558 (62%) had uncomplicated appendicitis. The overall incidence rate of neoplasm was 1.98%. No significant difference was found in the incidence rate of appendiceal neoplasm between complicated (3.29%) and uncomplicated (1.49%) appendicitis (OR 0.44, 95% CI 0.16- 1.23; p < 0.087; I2 = 54.9%). The most common appendiceal neoplasms were Neuroendocrine Tumors (NET) (49.21%), Nonmucinous Adenocarcinoma (24.24%), Mixed Adeno-Neuroendocrine Tumor (MANEC) (11.40%), Mucinous Adenocarcinoma (4.44%). There was a significant difference between complicated and uncomplicated appendicitis in rates of adenocarcinoma (50% vs. 13%), NET (31% vs. 74%), MANEC (19% vs. 13%) (P < 0.001). CONCLUSION While there was no significant difference in the overall neoplasm rate between complicated and uncomplicated appendicitis, the NET rate was significantly higher in uncomplicated appendicitis. In comparison, the Adenocarcinoma rate was considerably higher in Complicated appendicitis. These findings emphasize the importance of evaluating risk factors for neoplasm when considering appendectomy in patients with appendicitis.
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Affiliation(s)
- Paola Solis-Pazmino
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- CaTaLiNA- Cancer de Tiroides en Latino América, Quito, Ecuador
| | | | - Kristina La
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Luis A Figueroa
- CaTaLiNA- Cancer de Tiroides en Latino América, Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | | | | | | | - Jason Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Yosef Nasseri
- Surgery Group Los Angeles, Los Angeles, CA, USA.
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Núñez-Rocha RE, Girón F, Rodríguez L, Camargo-Gómez D, Restrepo-Bonilla C, Panqueva RDPL, Cadena M, Nassar R, Herrera-Almario GE, Hernández-Restrepo JD. Incidence of appendiceal neoplasms in appendectomy patients. BMC Surg 2023; 23:287. [PMID: 37735406 PMCID: PMC10512515 DOI: 10.1186/s12893-023-02183-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Non-operative management has been suggested as a therapy for uncomplicated appendicitis. Notwithstanding, the risk of missing an appendiceal tumor must be considered, being the surgical piece crucial to rule out neoplasms. Therefore, we aim to determine the incidence of appendiceal neoplasms in patients with acute appendicitis, tumor types and the importance of the anatomopathological study of the surgical piece. STUDY DESIGN Retrospective study in which we described patients who underwent emergent appendectomy with histopathological findings of appendiceal neoplasms from January 2012 to September 2018. Descriptive analysis included demographic variables, diagnostic methods, and surgical techniques. RESULTS 2993 patients diagnosed with acute appendicitis who underwent an emergency appendectomy. 64 neoplasms of the appendix were found with an incidence of 2,14%. 67.2% were women, the mean age was 46,4 years (± 19.5). The most frequent appendiceal neoplasms were neuroendocrine tumors (42,2%), followed by appendiceal mucinous neoplasms (35,9%), sessile serrated adenomas (18,8%), and adenocarcinomas (3,1%). In 89,1% of the cases, acute appendicitis was determined by imaging, and 14% of cases were suspected intraoperatively. Appendectomy was performed in 78,1% without additional procedures. CONCLUSIONS Appendiceal tumors are rare and must be ruled out in patients with suspected acute appendicitis. The incidence of incidental neoplasms is higher in this study than in the previously reported series. This information must be included in decision-making when considering treatment options for acute appendicitis.
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Affiliation(s)
- Ricardo E Núñez-Rocha
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Felipe Girón
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia.
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia.
| | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | | | | | - Rocío Del Pilar López Panqueva
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Manuel Cadena
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Ricardo Nassar
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Gabriel E Herrera-Almario
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Juan David Hernández-Restrepo
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
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Viennet M, Tapia S, Cottenet J, Bernard A, Ortega-Deballon P, Quantin C. Increased risk of colon cancer after acute appendicitis: a nationwide, population-based study. EClinicalMedicine 2023; 63:102196. [PMID: 37680941 PMCID: PMC10480545 DOI: 10.1016/j.eclinm.2023.102196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Background Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis. Methods Using the French Hospital Discharge Database (PMSI), we included all patients aged 18-59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients vs a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded. Findings A total of 230,349 patients with acute appendicitis (exposed group) were included. We used a propensity score to match each exposed patient with two unexposed patients (controls) to ensure the comparability of the groups, resulting in a control group of 460,698 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 1 per 10,000, p < 0.000, this corresponds to 111 patients in the appendicitis group), namely within the first 6 months. Survival analysis confirmed patients treated for appendicitis present a 4 times higher risk of being diagnosed with colon cancer than control patients during the first year of follow-up (sHR = 4.67 (95% CI: 3.51-6.21), and 8 times higher during the first 6 months (sHR = 8.39; 95% CI: 5.41-12.99). The association was even more marked for right-sided colon cancer (sHR = 8.25; 95% CI: 5.03-13.54 during the 1st year). While the risk of diagnosis of colon cancer was also significant for patients over 40 years, it was even greater in patients under 40 years, who had between a 6-fold and 12-fold increase in risk. Interpretation In this population-based study, we found that acute appendicitis seems to be a warning sign for colon cancer (reverse causality) in both middle-aged and younger adults. The risk of presenting with cancer colon was higher during the first six months after acute appendicitis. This raises the issue of routine diagnostic work-up in adults presenting with acute appendicitis. Funding Regional Council of Burgundy.
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Affiliation(s)
- Manon Viennet
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
| | - Solène Tapia
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Alain Bernard
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
- Inserm Unit 1231, Locoregional Therapy in Surgical Oncology, Dijon, France
| | - Catherine Quantin
- Department Medical Information, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
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10
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Malik AK, Innes AH, Reddy L, Munro C, Phillips AW. Appendicectomy remains treatment of choice for patients with acute appendicitis. BMJ 2023; 382:e074652. [PMID: 37604515 DOI: 10.1136/bmj-2022-074652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Abdullah K Malik
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
- Liver Unit, Freeman Hospital, Newcastle upon Tyne
| | - Ailsa H Innes
- Department of Surgery, Queen Elizabeth Hospital, Gateshead, UK
| | - Lomalan Reddy
- Saltaire and Windhill Medical Partnership, Bradford, UK
| | - Clara Munro
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne
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11
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Xu H, Yang S, Xing J, Wang Y, Sun W, Rong L, Liu H. Comparison of the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis: a systematic review and meta-analysis. BMC Surg 2023; 23:208. [PMID: 37488583 PMCID: PMC10367319 DOI: 10.1186/s12893-023-02108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to compare the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis. METHODS We searched the randomized controlled studies (RCTs) comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis in the electronic database including Pubmed, Embase, Cochrane, Web of Science, CNKI, VIP, and WanFang. The primary outcomes included complication-free treatment success at 1 year, complications, surgical complications, and the complicated appendicitis rates. Secondary outcomes included negative appendicitis, length of hospital stay, the quality of life at 1 month, and the impact of an appendicolith on antibiotic therapy. RESULTS Twelve randomized controlled studies were included. Compared with surgery group, the antibiotic group decreased the complication-free treatment success at 1 year (RR 0.81; 95% CI 0.73-0.91; z = 3.65; p = 0.000). Statistically significance was existed between antibiotic group and surgical group with both surgical types(open and laparoscopic) (RR 0.43; 95% CI 0.31-0.58; z = 5.36; p = 0.000), while no between the antibiotic treatment and laparoscopic surgery (RR 0.72; 95% CI 0.41-1.24; z = 1.19; p = 0.236). There was no statistically significant differences between two groups of surgical complications (RR 1.38; 95% CI 0.70-2.73; z = 0.93; p = 0.353), the complicated appendicitis rate (RR 0.71; 95% CI 0.36-1.42; z = 0.96; p = 0.338), negative appendectomy rate (RR 1.11; 95% CI 0.69-1.79; z = 0.43; p = 0.670), duration of hospital stay (SMD 0.08; 95%CI -0.11-0.27; z = 0.80; p = 0.422), and quality of life at 1 month (SMD 0.09; 95%CI -0.03-0.20; z = 1.53; p = 0.127). However, in the antibiotic treatment group, appendicolith rates were statistically higher in those whose symptoms did not improve (RR 2.94; 95% CI 1.28-6.74; z = 2.55; p = 0.011). CONCLUSIONS Although the cure rate of antibiotics is lower than surgery, antibiotic treatment is still a reasonable option for patients with uncomplicated acute appendicitis who do not want surgery without having to worry about complications or complicating the original illness.
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Affiliation(s)
- Hongxia Xu
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China.
| | - Shaohui Yang
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
| | - Jiankun Xing
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
| | - Yan Wang
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
| | - Weiqiang Sun
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
| | - Lingyan Rong
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
| | - Huihui Liu
- Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China
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12
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Rencuzogullari A, Atar C, Topal U, Coğal İ, Saritas AG, Yalav O, Dalci K, Eray İC. Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20220714. [PMID: 37222313 DOI: 10.1590/1806-9282.20220714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/24/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.
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Affiliation(s)
- Ahmet Rencuzogullari
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Cihan Atar
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Ugur Topal
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - İbrahim Coğal
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Ahmet Gokhan Saritas
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Orcun Yalav
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Kubilay Dalci
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - İsmail Cem Eray
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
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Xing X, Zhang Y, Wang L, Wang Y, Zhang Z, Li Z, Li M. Discussion on the benefits of different treatment strategies in elderly and non-elderly patients with appendix MiNEN: a retrospective study based on SEER database. Int J Colorectal Dis 2023; 38:93. [PMID: 37039889 DOI: 10.1007/s00384-023-04384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To investigate the benefits of surgery alone and postoperative chemotherapy in elderly and non-elderly patients with appendiceal mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) and analyze the factors affecting the prognosis of patients with MiNEN of the appendix. METHODS Based on the Surveillance, Epidemiology, and End Results database (SEER) of the National Cancer Institute of the USA, 389 patients with appendiceal MiNENs from 2000 to 2016 were collected. All patients were distributed in the elderly group (≥ 60 years old) and the non-elderly group (< 60 years old) according to their age. The prognosis of the two groups of patients who received simple surgery and postoperative chemotherapy was analyzed and compared. The two treatment methods of the two tranches were matched by propensity score matching method. The effect of different treatment ways on the prognosis of sick persons was compared. The survivorship curves were painted by the Kaplan Meier method, log rank test was used to analyze the subsistence discrepancy of each group, and COX proportional risk model was used to analyze the factors affecting the prognosis of patients with appendiceal MiNENs. RESULTS No matter the overall survival rate (OS) or cancer-specific mortality (CSM) of the two treatment schemes, the prognosis of patients in the only surgery group was meaningfully higher than that in the postoperative chemotherapy group, with statistically significant difference in component comparison (χ2 = 16.496, χ2 = 16.860, P < 0.001). After propensity score matching of patients in each group, there was no striking discrepancy in the OS of patients in the only surgery group compared with those in the postoperative chemotherapy group, regardless of whether they were elderly patients or non-elderly patients (χ2 = 3.205, χ2 = 1.521, all P > 0.05), the CSM consequences are fitting in with the OS. The consequences of the multivariate COX regression model showed that age (≥ 60 years old), sex (female), high histological grade, and lymph node positive were all the influencing factors for the poor OS of patients with MiNEN; the CSM results are consistent with the OS. CONCLUSION For patients with appendix MiNEN, whether elderly or non-elderly patients (especially for non-elderly patients), surgical treatment may be a better choice.
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Affiliation(s)
- Xiaoyang Xing
- Graduate School of Hebei Medical University, No. 361, Zhongshan East Road, Changan District, Shijiazhuang Province, 050011, China
| | - Yongyan Zhang
- Geriatrics (International Medical Department Fangbei), Shijiazhuang People's Hospital, No. 9, Fangbei Road, Changan District, Shijiazhuang Province, 050011, China
| | - Liwei Wang
- General Surgery, Shijiazhuang People's Hospital, No. 36 Fanxi Road, Changan District, Shijiazhuang Province, 050011, China
| | - Yingxin Wang
- General Surgery, Shijiazhuang People's Hospital, No. 36 Fanxi Road, Changan District, Shijiazhuang Province, 050011, China
| | - Zhenduo Zhang
- General Surgery, Shijiazhuang People's Hospital, No. 36 Fanxi Road, Changan District, Shijiazhuang Province, 050011, China
| | - Zhong Li
- General Surgery, Shijiazhuang People's Hospital, No. 36 Fanxi Road, Changan District, Shijiazhuang Province, 050011, China
| | - Ming Li
- General Surgery, Shijiazhuang People's Hospital, No. 36 Fanxi Road, Changan District, Shijiazhuang Province, 050011, China.
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14
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Sugimoto T, Nagasue Y, Tanaka E, Yokomizo H. Comparison of the risk of appendiceal tumors in uncomplicated and complicated appendicitis. Surg Endosc 2022; 36:8107-8111. [PMID: 35449477 DOI: 10.1007/s00464-022-09246-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Interval appendectomy or non-operative management is commonly performed for complicated appendicitis in adult patients. However, these treatments are still controversial because the incidence rate of appendiceal tumors recognized after interval appendectomy is reportedly higher than that after emergency appendectomy. Thus, this study aimed to compare the appendiceal tumor rates between uncomplicated and complicated appendicitis. METHODS This study was a retrospective review of patients with appendicitis who underwent surgical removal at a single institution over 7.5 years. The primary objective was the comparison of the incidence rate of appendiceal tumors using propensity score matching, and the secondary objective was the same comparison among older patients, defined as patients aged ≥ 60 years. RESULTS A total of 1277 patients were included. Of these patients, 297 (23.3%) were preoperatively diagnosed with complicated appendicitis. Moreover, 22 (1.7%) patients, including 14 cases of complicated appendicitis and 8 cases of uncomplicated appendicitis, were diagnosed with appendiceal tumors based on pathological examination. No significant difference was found in the incidence rate of appendiceal tumors between the two groups after matching for patients' background, including age, sex, and history of appendicitis by propensity score matching (P = 0.073). However, among patients aged ≥ 60 years, the incidence of appendiceal tumors was significantly higher in complicated than in uncomplicated appendicitis (P = 0.006). CONCLUSIONS Although the overall risk of appendiceal tumors did not differ between complicated and uncomplicated appendicitis when analyzed by the propensity score matching, in older patients aged ≥ 60 years, the risk increased among those with complicated appendicitis. Therefore, although the incidence is low, complicated appendicitis, particularly, among older patients, should be examined carefully and be performed IA when unusual findings exist.
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Affiliation(s)
- Takuya Sugimoto
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan.
| | - Yasutomo Nagasue
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
| | - Eiji Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
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15
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Duraiswamy S, Sanchez SE, Flum DR, Paasche-Orlow MK, Kenzik KM, Tseng JF, Drake FT. Caveat emptor: The accuracy of claims data in appendicitis research. Surgery 2022; 172:1050-1056. [PMID: 35985898 DOI: 10.1016/j.surg.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND International Classification of Disease, ninth/tenth revision codes are used to identify patients with appendicitis and classify severity of disease for research and hospital reimbursement. We sought to determine accuracy of International Classification of Disease, ninth/tenth revision codes in classifying appendicitis as uncomplicated versus complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report. METHODS Retrospective review of operative reports and discharge International Classification of Disease, ninth/tenth revision codes for patients ≥18 years old who underwent noninterval, nonincidental appendectomy between January 2012 and December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for International Classification of Disease, ninth/tenth revision codes to classify appendicitis accurately as complicated compared with surgeon description. ICD-9/10 codes and surgeon description were categorized into complicated/uncomplicated based on the American Association for the Surgery of Trauma grading system. RESULTS In the study, 1,495 patients with acute appendicitis underwent appendectomy. Per surgeon description, 200 (13%) were complicated and 1,295 (87%) uncomplicated. Compared with surgeon description, discharge International Classification of Disease, ninth/tenth revision codes did not accurately identify complicated appendicitis: sensitivity = 0.68, positive predictive value = 0.77. As a sensitivity analysis, the cohort was stratified by public versus private payers, and the results did not change. CONCLUSION International Classification of Disease, ninth/tenth revision codes do not accurately identify surgeon-described complicated appendicitis. Nearly one-third of the cases of complicated appendicitis were coded as uncomplicated. Such misclassification negatively impacts reimbursement for complicated appendicitis care and could lead to misleading results in research and quality improvement activities that rely on these codes.
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Affiliation(s)
- Swetha Duraiswamy
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA.
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - David R Flum
- Department of Surgery, University of Washington Medical Center, Seattle, WA
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Frederick Thurston Drake
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA. https://twitter.com/F_ThurstonDrake
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16
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Appendectomy versus nonoperative management of simple appendicitis: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study using a hierarchical ordinal scale. J Trauma Acute Care Surg 2022; 92:1031-1038. [PMID: 35195095 DOI: 10.1097/ta.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Controversy exists about the preferred initial treatment of appendicitis. We sought to compare the two treatments for initial management of simple appendicitis. METHODS In this post hoc analysis of the Multicenter Study for the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, subjects were divided into appendectomy or nonoperative management (NOM; antibiotics only or percutaneous drainage) cohorts. A novel topic-specific hierarchical ordinal scale was created with eight mutually exclusive categories: mortality, reoperation, other secondary interventions, readmission, emergency department visit, wound complication, surgical site infection, and no complication. Pairwise comparisons of American Association for the Surgery of Trauma Imaging Severity Grade 1 (simple appendicitis) patients were compared using win-lose-tie scoring and the sums of appendectomy/NOM groups were compared. RESULTS A total 3,591 subjects were included: 3,262 appendectomy and 329 NOM, with significant differences in baseline characteristics between groups. Across 28 sites, the rate of NOM ranged from 0% to 48%, and the loss to follow-up rate was significantly higher for NOM compared with appendectomy (16.5% vs. 8.7%, p = 0.024). In the simple appendicitis hierarchical ordinal scale analysis, 2,319 subjects resulted in 8,714,304 pairwise comparisons; 75% of comparisons resulted in ties. The median (interquartile range) sums for the two groups are as follows: surgical, 400 (400-400), and NOM, 400 (-2,427 to 400) (p < 0.001). A larger proportion of appendectomy subjects (88.1%) had an outcome that was equivalent (or better) than at least half of the subjects compared with NOM subjects (NOM, 70.5%; OR [95% confidence interval], 0.3 [0.2-0.4]). CONCLUSION In contemporary American practice, appendectomy (compared with NOM) for simple appendicitis is associated with lower odds of developing clinically important unfavorable outcomes in the first year after illness. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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17
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Bayissa BB, Miressa F, Abulkadir A, Fekadu G. Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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The association between appendicitis severity and patient age with appendiceal neoplasm histology-a population-based study. Int J Colorectal Dis 2022; 37:1173-1180. [PMID: 35474547 PMCID: PMC9072484 DOI: 10.1007/s00384-022-04132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Recent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology. METHODS This nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor. RESULTS The severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98-32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69-9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95-88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67). CONCLUSION More malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.
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19
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Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel) 2021; 6:geriatrics6030093. [PMID: 34562994 PMCID: PMC8482159 DOI: 10.3390/geriatrics6030093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
With increased life expectancy and the growing total population of elderly patients, there has been rise in the number of cases of acute appendicitis in elderly people. Although acute appendicitis is not the most typical pathological condition in the elderly, it is not uncommon. Most of these patients require surgical treatment, and as with any acute surgical pathology in advanced age, treatment possibilities are affected by comorbidities, overall health status, and an increased risk of complications. In this literature review we discuss differences in acute appendicitis in the elderly population, with a focus on clinical signs, diagnostics, pathogenesis, treatment, and results.
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20
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Faggionato A. Appendiceal neuroendocrine tumour (carcinoid): Case report of a rare appendiceal tumour. SONOGRAPHY 2021. [DOI: 10.1002/sono.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ashlee Faggionato
- Department of Medical Imaging Alice Springs Hospital Alice Springs Northern Territory Australia
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21
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Skendelas JP, Alemany VS, Au V, Rao D, McNelis J, Kim PK. Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age. BMC Surg 2021; 21:228. [PMID: 33934697 PMCID: PMC8088755 DOI: 10.1186/s12893-021-01224-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 02/20/2023] Open
Abstract
Background Appendectomy 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. Methods The 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. Results We 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. Conclusions Appendiceal 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.
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Affiliation(s)
- John P Skendelas
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Vincent Au
- Jacobi Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Devika Rao
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - John McNelis
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter K Kim
- Jacobi Medical Center, Bronx, NY, USA. .,North Central Bronx Hospital, Bronx, NY, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA. .,Jacobi Medical Center, 1400 Pelham Parkway, Building 1, Room 510, Bronx, NY, 10461, USA.
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22
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Vicario Bravo M, Chavarrías Torija N, Rubio-Pérez I. Digestive symptoms and COVID-19: Importance of ruling out associated surgical pathology. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2021. [PMID: 32553858 PMCID: PMC8062418 DOI: 10.1016/j.cireng.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
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23
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Vicario Bravo M, Chavarrías Torija N, Rubio-Pérez I. [Digestive symptoms and COVID-19: Importance of ruling out associated surgical pathology]. Cir Esp 2021; 99:385-387. [PMID: 38620272 PMCID: PMC7264039 DOI: 10.1016/j.ciresp.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
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Bekki T, Fukuda T, Moriuchi T, Namba Y, Okimoto S, Mukai S, Saito Y, Oishi K, Nishida T, Ohdan H. Appendicitis with submucosal fecalith mimicking a submucosal tumor: a case report. Surg Case Rep 2021; 7:105. [PMID: 33905033 PMCID: PMC8079595 DOI: 10.1186/s40792-021-01169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Submucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare. Moreover, accurate preoperative diagnosis of these entities is exceedingly difficult, and the mechanism(s) of their formation remains unclear. Case presentation A 40-year-old woman visited the authors’ hospital due to lower abdominal pain and diarrhea. She had previously been treated for endometriosis. Laboratory investigation revealed increased C-reactive protein levels. Abdominal contrast-enhanced computed tomography revealed thickening of the appendix wall and dilation of the small intestine. The patient was diagnosed with paralytic ileus caused by appendicitis, and interval appendectomy was scheduled. She underwent laparoscopic-assisted appendectomy after conservative treatment. Partial cecal resection was selected due to the presence of an elastic mass in the cecum. The final pathological diagnosis was submucosal fecalith, not submucosal tumor. On day 5, the patient was discharged without any postoperative complications. Conclusions In cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan. .,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | | | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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25
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Peltrini R, Cantoni V, Green R, Lionetti R, D'Ambra M, Bartolini C, De Luca M, Bracale U, Cuocolo A, Corcione F. Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis. Surgeon 2021; 19:e549-e558. [PMID: 33640282 DOI: 10.1016/j.surge.2021.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-operative management is often the treatment of choice in cases of complicated appendicitis and routine interval appendectomy is not usually recommended. Actually, recent studies show an alarming number of appendiceal neoplasms following interval appendectomy. The aim of this study is to evaluate the prevalence of appendiceal neoplasms and their histological types after interval appendectomy for complicated appendicitis in adults. METHODS A comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement. Studies reporting appendiceal neoplasm rates after interval appendectomy and histopathological characteristics were included. The most recent World Health Organization (WHO) classification of malignant tumours was considered. A pooled prevalence analysis for both prevalence and pathology was performed. RESULTS A total of eight studies was included: seven retrospective series and one randomized controlled trial. The pooled prevalence of neoplasms after interval appendectomy was 11% (95% CI 7-15; I2 = 37.5%, p = 0.13). Appendiceal mucinous neoplasms occurred in 43% (95% CI 19-68), adenocarcinoma in 29% (95% CI 6-51), appendiceal neuroendocrine neoplasm in 21% (95% CI 6-36), globet cell carcinoma in 13% (95% CI -2-28), adenoma or serrated lesions in 20% (95% CI -0-41) of cases. CONCLUSION The risk of appendiceal neoplasm in patients treated with interval appendectomy for complicated appendicitis is 11%; mucinous neoplasm is the most common histopathological type. Further studies should investigate this association in order to clarify the biological pathway and clinical implications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Carolina Bartolini
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Marcello De Luca
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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26
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Mikaeel RR, Young JP, Hardingham JE, Tapia Rico G, Hewett PJ, Symonds EL, Edwards S, Smith E, Tomita Y, Uylaki W, Horsnell M, Price TJ. Appendiceal neoplasm incidence and mortality rates are on the rise in Australia. Expert Rev Gastroenterol Hepatol 2021; 15:203-210. [PMID: 33022181 DOI: 10.1080/17474124.2021.1832467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The study aimed to examine the incidence and mortality rates of appendiceal neoplasms (ANs) in Australia. METHODS A retrospective analysis was performed on national data obtained from the Australian Institute of Health and Welfare (AIHW) from 1982 to 2013. Changes to the incidence, and the cancer-specific mortality following the diagnosis of ANs were analyzed over this time period, with stratification performed for histological subtype, gender, and age groups (<50y and ≥50y). RESULTS Incidence and mortality rates of ANs increased significantly across both genders and age groups. Incidence rates increased by 415%, from 0.40/100 000 population in 1982 to 2.06/100 000 in 2013. Overall mortality rates increased by 130%, from 0.057/100 000 during 1982-1985 to 0.131/100 000 during 2010-2013. Controlling for age group and gender, the incidence rates increased by 20% every four years (Incidence rate ratio (IRR) = 1.20, 95% confidence interval (CI): 1.17, 1.23, global P value<0.0001), and controlling for age, the mortality rates increased by 8% every four years (IRR = 1.08, 95% CI: 1.00, 1.17, global P-value = 0.0401). CONCLUSION The increasing use of CT scanning, improvements in pathological assessment of the appendix, and the growing aging population may have contributed in part to the apparent rise in the incidence of ANs.
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Affiliation(s)
- Reger R Mikaeel
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute , Woodville South, Australia.,Faculty of Health and Medical Sciences, University of Adelaide , Adelaide, Australia.,Department of Biology, College of Science, University of Duhok , Duhok, Kurdistan
| | - Joanne P Young
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute , Woodville South, Australia.,Faculty of Health and Medical Sciences, University of Adelaide , Adelaide, Australia
| | - Jennifer E Hardingham
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute , Woodville South, Australia.,Faculty of Health and Medical Sciences, University of Adelaide , Adelaide, Australia
| | - Gonzalo Tapia Rico
- Department of Medical Oncology, Royal Adelaide Hospital , Adelaide, Australia
| | - Peter J Hewett
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital , Woodville South, Australia
| | - Erin L Symonds
- Bowel Health Service, Flinders Medical Centre , Bedford Park, Australia.,Finders Centre for Innovation in Cancer, Flinders University , Bedford Park, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide , Adelaide, Australia
| | - Eric Smith
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,University of Adelaide Department of Surgery, The Queen Elizabeth Hospital , Woodville South, Australia
| | - Yoko Tomita
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia
| | - Wendy Uylaki
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital , Woodville South, Australia
| | - Mehgan Horsnell
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia
| | - Timothy J Price
- Department of Haematology and Oncology, The Queen Elizabeth Hospital , Woodville South, Australia.,Faculty of Health and Medical Sciences, University of Adelaide , Adelaide, Australia
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Monsonis B, Zins M, Orliac C, Mandoul C, Boulay-Coletta I, Curros-Doyon F, Molinari N, Taourel P, Millet I. Retrospective case-control study to predict a potential underlying appendiceal tumor in an acute appendicitis context based on a CT-scoring system. Eur J Radiol 2021; 136:109525. [PMID: 33454458 DOI: 10.1016/j.ejrad.2021.109525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/26/2020] [Accepted: 01/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess CT signs to discriminate an appendiceal tumor versus a non-tumoral appendix in an acute appendicitis context. METHODS A 10-year bicentric retrospective case-control study was performed in adults. Patients with a histopathological appendiceal tumor and appendicitis were paired for age and sex with patients with non-tumorous appendicitis (1/3 ratio, respectively). Two senior radiologists blindly analyzed numerous CT findings with final consensus to perform univariate and multivariate statistical analyses. A diagnostic CT scan score was calculated with a bootstrap internal validation. Reproducibility was assessed based on the kappa statistic. RESULTS A total of 208 patients (51 +/- 21 years; 114 males) were included (52 patients in the tumor group and 156 in the non-tumor group). In the multivariate analysis, an appendicolith and fat stranding were protective factors with OR = 0.2 (p = 0.01) and OR = 0.3 (p = 0.02), respectively, while mural calcifications (OR = 47, p = 0.0001), an appendix mass (OR = 7.1, p = 0.008), a focal asymmetric wall abnormality (OR = 4.9, p = 0, 001), or a ≥ 15 mm diameter (OR = 3.5, p = 0.009) were positive predictive factors of an underlying tumor. Using a ≥1 cut-off, our diagnostic score had an AUC = 0.87 (95 % CI, 0.82-0.93) and a positive likelihood ratio = 13.5 (95 % CI, 6.7-27.1). CONCLUSION We developed a reliable scoring system based on CT findings, which is highly predictive of an underlying appendiceal neoplasm in an appendicitis context using a ≥1 cut-off.
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Affiliation(s)
- B Monsonis
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - M Zins
- Department of Medical Imaging, Saint Joseph's Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - C Orliac
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - C Mandoul
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France; University of Montpellier, France
| | - I Boulay-Coletta
- Department of Medical Imaging, Saint Joseph's Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - F Curros-Doyon
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - N Molinari
- Department of Statistics, Montpellier University Hospital, 39 Avenue Charles Flahault, 34090, Montpellier, France; University of Montpellier, France
| | - P Taourel
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France; University of Montpellier, France
| | - I Millet
- Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France; University of Montpellier, France.
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28
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Mangieri CW, Moaven O, Votanopoulos KI, Shen P, Levine EA. Quality analysis of operative reports and referral data for appendiceal neoplasms with peritoneal dissemination. Surgery 2020; 169:790-795. [PMID: 33190916 DOI: 10.1016/j.surg.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peritoneal metastasis from appendiceal neoplasms is a rare disease usually found unexpectedly and is associated with deficits in quality reporting of findings. METHODS Retrospective review of our appendiceal peritoneal metastases carcinomatosis database evaluating quality of index operative and pathology reports. Operative report quality was graded by 2 standards; general quality, based on Royal College of Surgeons quality metrics and peritoneal metastases assessment. Pathology report quality was assessed by the accuracy of diagnosis. RESULTS Three hundred and seventy-five index operative reports and 490 outside pathology reports were reviewed. General quality of the index operative reports was excellent, with nearly 80% of reports encompassing all the Royal College of Surgeons quality metrics. Peritoneal metastases assessment was poor. Forty-four percent of the reports performed no peritoneal evaluation, while 48.3% only involved partial peritoneal evaluation. Only 7.7% of the reports performed a complete evaluation. Of the pathology reports, 48.4% had discrepancies with final pathologic findings. Low-grade disease and high-grade disease were misdiagnosed 36.06% and 62.7% of the time, respectively. Discordant treatment occurred in 15.3% and 30.0% of cases for misdiagnosed low-grade and high-grade disease, respectively. Incomplete cytoreduction was attempted in nearly a third of referral cases, which was associated with a significantly increased risk for ultimate incomplete cytoreduction with an odds ratio of 4.72. CONCLUSION This review finds that referral operative reports' descriptions of the technical aspects of a procedure is usually complete. However, oncologic parameters and descriptions of peritoneal metastases are frequently incomplete. Further, pathology reports from outside institutions can lead to inappropriate clinical management decisions. We propose a simplified algorithm to assist nonperitoneal surface malignancy surgeons.
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Affiliation(s)
- Christopher W Mangieri
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC
| | - Omeed Moaven
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC
| | | | - Perry Shen
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC
| | - Edward A Levine
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC.
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29
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Shannon AB, Song Y, Roses RE, Fraker DL, Miura JT, Karakousis GC. National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade. J Surg Oncol 2020; 123:606-613. [PMID: 33169840 DOI: 10.1002/jso.26295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rates of nonoperative management of acute appendicitis and appendiceal adenocarcinoma have increased over a decade, but the presentation and outcomes of appendiceal adenocarcinoma over this period is not well-characterized. METHODS Patients with surgically resected Stage I-III appendiceal adenocarcinoma were identified from the 2006 to 2015 National Cancer Data Base and classified into two cohorts, 2006-2010 and 2011-2015, based on year of diagnosis. Three-year overall survival (OS) was analyzed using Cox proportional hazards regression and Kaplan-Meier survival estimates. RESULTS Of 4233 patients, 1369 (32.3%) and 2864 (67.7%) were diagnosed in 2006-2010 and 2011-2015, respectively. Following multivariable analysis, patients in 2011-2015 were more likely to be <40 years of age (6.4% vs. 4.7%, odds ratio [OR] 1.53, p .015), present with pT4 tumors (40.2% vs. 34.4%, OR 1.46, p .004), and undergo hyperthermic intraperitoneal chemotherapy (4.4% vs. 2.4%, OR 1.97, p .001). Comparing patients diagnosed in 2011-2015 to 2006-2010, adjusted 3-year OS was no different among all patients (81.1% vs. 79%, p .778). CONCLUSIONS There has been an increase in the proportion of patients with pT4 appendix tumors over time, primarily among older (≥60 years) patients. Even so, these shifts in presentation have not resulted in differences in survival outcomes.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert E Roses
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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30
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Bolmers MDM, de Jonge J, van Rossem CC, van Geloven AAW, Bemelman WA. Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis. Int J Colorectal Dis 2020; 35:2065-2071. [PMID: 32638091 PMCID: PMC7541364 DOI: 10.1007/s00384-020-03673-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm. METHODS Data was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy. RESULTS A total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up. DISCUSSION The incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified.
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Affiliation(s)
- M D M Bolmers
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands.
| | - J de Jonge
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands
| | - C C van Rossem
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - A A W van Geloven
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands
| | - W A Bemelman
- Department of surgery, Academic Medical Center, Amsterdam, The Netherlands
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31
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Preoperative computed tomography is poor in detecting tumors of the appendix among patients with acute appendicitis: A cohort study of 5,224 appendectomies. J Trauma Acute Care Surg 2020; 88:396-401. [PMID: 32107355 DOI: 10.1097/ta.0000000000002567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neoplastic processes are among the known etiologies for acute appendicitis. While conservative treatment with antibiotics alone has been proposed as a treatment for uncomplicated appendicitis, the presence of tumors should be excluded when offering patients this option. The aim of this study was to assess the accuracy of computed tomography (CT) in detecting appendiceal tumors. METHOD Consecutive patients operated on for acute appendicitis between January 2007 and October 3, 2018, in our university hospital were included. Whenever appendiceal tumor was histopathologically confirmed, CT interpretations and surgical reports were carefully reviewed. All CT scans were reanalyzed by consultant body radiologists. Discrepancies between the preliminary and final radiological interpretations were noted. RESULTS A total of 5,224 patients underwent appendectomy, of whom 4,766 had histopathologically confirmed acute appendicitis. Eighty-four patients (median, 61 (13-89) years; 54% female) were diagnosed with appendiceal tumor. Fifty-two patients (62%) had uncomplicated appendicitis. Although incidence of tumors was associated with older age, tumors were found in all ages. The share of tumors increased from 1.7% to 3.0%/year during the study. The most common tumors were neuroendocrine tumors (n = 33), low-grade appendiceal mucinous neoplasms (n = 14), and adenocarcinomas (n = 11). Sixty-one patients (73%) underwent preoperative CT. Computed tomography interpretation during on-call hours suspected tumor in only one case (3.4%) with invasive tumor, and in five cases (16%) with noninvasive tumor. CONCLUSION Appendiceal tumors are possible findings in appendix specimens, and most patients had uncomplicated acute appendicitis. In light of findings we conclude that CT cannot be used to exclude neoplastic etiology underlying acute appendicitis. LEVEL OF EVIDENCE Diagnostic, level IV.
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32
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Al-Tarakji M, Muhammad Ali S, Khalaf M, Shahid F, Mohamed SSI. Adenocarcinoma of Stump Appendicitis: An Extremely Rare Pathology - A Literature Review. Cureus 2020; 12:e9482. [PMID: 32874810 PMCID: PMC7455462 DOI: 10.7759/cureus.9482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Emergency appendectomy for acute appendicitis is the most common emergency surgical procedure performed all over the world. While amputating the appendix from the cecum, a small (usually less than 5 mm) stump is left behind. Below this, the suture or stapler is applied to secure the base of the appendix, which is now known as a stump. Stump appendicitis, the inflammation of appendiceal remnant after an appendectomy, is a rare phenomenon. Additionally, the incidence of adenocarcinoma in the stump of the appendix is also extremely rare and can present with the symptoms of appendicitis. Adenocarcinoma in stump appendectomy patients can present from 5-43 years after the index appendectomy surgery. The majority of patients present with symptoms similar to that of appendicitis, with right lower quadrant abdominal pain, usually diagnosed via CT scans, after which they undergo stump appendectomy. The diagnosis of adenocarcinoma is only made on the histopathology report. We engaged in a review of the relevant literature published in the English language for the last 100 years. This was conducted by reviewing Google Scholar, PubMed, and MEDLINE® databases, as well as references to all related articles. There are only six cases reported in the literature, which shows the rarity of this condition. Regarding the appropriate treatment for this rare entity, multi-disciplinary team discussions should be carried out for optimum management of the individual patients. Right hemicolectomy is the recommended procedure for all patients, and prognosis depends on the staging of the disease.
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Affiliation(s)
| | - Syed Muhammad Ali
- Acute Care Surgery, Hamad General Hospital, Doha, QAT.,Surgery, Weill-Cornell Medical School, Doha, QAT
| | | | - Fakhar Shahid
- General Surgery, Hamad Medical Corporation, Doha, QAT
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33
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Naar L, Kim P, Byerly S, Vasileiou G, Zhang H, Yeh DD, Kaafarani HMA. Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study. Surgery 2020; 168:701-706. [PMID: 32739139 DOI: 10.1016/j.surg.2020.05.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy. METHODS Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit. RESULTS A total of 3,293 patients were included. The median age was 38 (27-53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5-67] vs 37 [27-52] years, P < .001), had longer duration of symptoms before presentation (36-41 vs 18-23 hours, P = .03), and were more likely to have a phlegmon on imaging (6.3% vs 1.3%, P = .03). Multivariable analyses showed that an enlarged appendiceal diameter was independently associated with malignancy (odds ratio = 1.06, 95% confidence interval = 1.01-1.12; P = .01). The incidence of malignancy in patients >40 years with an appendiceal diameter >10 mm on computed tomography was 2.95% compared with 0.97% in patients ≤40 years old with appendiceal diameter ≤10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24-7.42; P = .02). CONCLUSION The combination of age >40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis.
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Affiliation(s)
- Leon Naar
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Peter Kim
- Department of General Surgery, Jacobi Medical Center and North Central Bronx Hospital, New York, NY
| | - Saskya Byerly
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Georgia Vasileiou
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Hang Zhang
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL
| | - D Dante Yeh
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Mima K, Miyanari N, Itoyama R, Nakao Y, Kato R, Shigaki H, Kurashige J, Inoue M, Iwagami S, Mizumoto T, Kubota T, Baba H. Interval laparoscopic appendectomy after antibiotic therapy for appendiceal abscess in elderly patients. Asian J Endosc Surg 2020; 13:311-318. [PMID: 31621202 DOI: 10.1111/ases.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the safety and efficacy of interval laparoscopic appendectomy after antibiotic therapy in elderly patients with appendiceal abscess. METHODS We retrospectively analyzed data for 50 patients with appendiceal abscess aged ≥18 years who had initially planned to undergo interval laparoscopic appendectomy after antibiotic therapy and 50 patients with appendicitis aged ≥70 years who had undergone early laparoscopic appendectomy. All patients were treated at the National Hospital Organization Kumamoto Medical Center between 2012 and 2018. We compared perioperative outcomes after interval appendectomy between patients aged <70 years and ≥70 years. RESULTS Clinical progression of appendicitis during antibiotic therapy developed in one patient (2.0%), and recurrent appendicitis after antibiotic therapy for appendiceal abscess occurred in two patients (4.0%). Pathological findings confirmed appendiceal neoplasms in four patients (8.0%). Postoperative infectious complications occurred in 1 of 47 patients (2.1%) who had undergone successful interval laparoscopic appendectomy, and the median length of postoperative hospital stay was 4 days (interquartile range, 3-5 days). There were no significant differences in outcomes after interval appendectomy between patients aged <70 years and ≥70 years. In the secondary analysis, the median length of postoperative hospital stay after interval laparoscopic appendectomy for appendiceal abscess (4 days) was significantly shorter than that after early laparoscopic appendectomy for uncomplicated appendicitis (7 days; P < .001). CONCLUSIONS Interval laparoscopic appendectomy for appendiceal abscess may be safe and effective in elderly patients without severe comorbidities. Interval appendectomy may be necessary for determining the underlying cause of appendiceal abscess in adults.
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Affiliation(s)
- Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Rikako Kato
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hironobu Shigaki
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junji Kurashige
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. [Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis]. ACTA ACUST UNITED AC 2020; 157:S33-S43. [PMID: 32355509 PMCID: PMC7190476 DOI: 10.1016/j.jchirv.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
La saturation intrahospitalière liée à l’arrivée massive de patients atteints du COVID-19 nécessitant une prise en charge urgente conduit à reconsidérer la prise en charge des autres patients. Différer au maximum les hospitalisations et les opérations chirurgicales non urgentes est un des objectifs des chirurgiens afin de désengorger autant que possible le système de soins. Alors que la majorité des opérations programmées sont annulées, la réduction de la chirurgie d’urgence est évidemment compliquée à proposer sans altérer la qualité de la prise en charge et conduire à une perte de chance pour le patient. Cependant, l’appendicite aiguë constitue une situation spécifique bien particulière et la fréquence de cette pathologie conduit à considérer ce cas particulier. En effet, tandis que le traitement recommandé de l’appendicite aiguë non compliquée est chirurgical, l’alternative non chirurgicale par antibiothérapie seule a été largement évaluée dans la littérature au cours de travaux de qualité. Dans la mesure où la limite principale du traitement médical exclusif de l’appendicite aiguë non compliquée est le risque de récidive à distance, cette option thérapeutique représente une alternative de choix pour réduire la surcharge intrahospitalière dans ce contexte de crise sanitaire. L’objectif de ce travail est donc de mettre à disposition des médecins et des chirurgiens un guide pratique issu d’une analyse de la littérature sur le traitement médical de l’appendicite aiguë non compliquée de l’adulte afin de pouvoir proposer ce traitement alternatif aux bons patients et dans des bonnes conditions, notamment lorsque l’accès au bloc opératoire est impossible.
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Affiliation(s)
- M Collard
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - Z Lakkis
- Service de chirurgie digestive et oncologique , et de transplantation hépatique, CHU de Besançon, 2, boulevard Alexander-Fleming, 25000, Besançon, France
| | - J Loriau
- Service de chirurgie viscérale, groupe hospitalier Paris Saint-Joseph, 75014, Paris, France
| | - D Mege
- Service de chirurgie digestive, assistance publique hôpitaux de Marseille, hôpital de la Timone, CHU de Marseille, France
| | - C Sabbagh
- Service de chirurgie digestive, CHU Amiens-Picardie, 8000 Amiens, France.,Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules-Verne, 80025 Amiens, France
| | - J H Lefevre
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - L Maggiori
- Service de chirurgie colorectale, hôpital Beaujon, université de Paris, AP-HP, 92110 Clichy, France
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Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg 2020; 157:S33-S42. [PMID: 32362368 PMCID: PMC7181971 DOI: 10.1016/j.jviscsurg.2020.04.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system. It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis. The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible.
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Affiliation(s)
- M Collard
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, 2, boulevard Alexander Fleming, 25000, Besançon, France
| | - J Loriau
- Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - D Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - C Sabbagh
- Digestive surgery department, CHU Amiens-Picardie, 80000 Amiens, France; Research Unit SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules Verne, 80025 Amiens, France
| | - J H Lefevre
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - L Maggiori
- Department of Colorectal surgery, Beaujon Hospital, Paris University, AP-HP, 92110, Clichy, France.
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Brunner M, Lapins P, Langheinrich M, Baecker J, Krautz C, Kersting S, Weber GF, Grützmann R, Maak M. Risk factors for appendiceal neoplasm and malignancy among patients with acute appendicitis. Int J Colorectal Dis 2020; 35:157-163. [PMID: 31811385 DOI: 10.1007/s00384-019-03453-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Philipp Lapins
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Melanie Langheinrich
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Justus Baecker
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Stephan Kersting
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Matthias Maak
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany
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Prechal D, Post S, Pechlivanidou I, Ronellenfitsch U. Feasibility, acceptance, safety, and effectiveness of antibiotic therapy as alternative treatment approach to appendectomy in uncomplicated acute appendicitis. Int J Colorectal Dis 2019; 34:1839-1847. [PMID: 31515616 DOI: 10.1007/s00384-019-03392-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Based on results from randomized controlled trials, there is an increasing discussion if antibiotic treatment is an equivalent therapeutic approach to appendectomy in uncomplicated acute appendicitis. This observational prospective study evaluates its feasibility, safety, and effectiveness in clinical practice. METHODS The study included all consecutive adults treated for acute appendicitis over an 18-month period in one hospital. Patients receiving antibiotics were compared to those treated surgically. Follow-up comprised 1 year. The primary endpoint was treatment success, defined as no secondary appendectomy during follow-up (antibiotic group) or successful appendectomy (primary surgical group). Secondary endpoints were complications, duration of hospital stay, pain intensity, and length of absence from work. RESULTS 54/124 (43.6%) patients were primarily treated with antibiotics and 70/124 (56.4%) surgically. Treatment success at 1 year was 77.1% (95%-CI 62.8-88%) for antibiotic and 100% for surgical treatment. Complications were non-significantly less frequent both among all patients treated with antibiotics and among patients undergoing secondary appendectomy compared to patients undergoing primary appendectomy (20.8% vs. 27.1% and 9.1% vs. 27.1%). The initial hospital stay was significantly shorter in the antibiotic group (mean 3.6 vs. 4.8 days, median 3 days, p = 0.03). After 1 year, the cumulative hospital stay was not different between groups. CONCLUSIONS Appendectomy remains the most effective treatment for the definitive cure of acute appendicitis. However, antibiotic therapy can be a safe alternative approach for selected patients with uncomplicated acute appendicitis. TRIAL REGISTRATION DRKS00010401.
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Affiliation(s)
- Daniela Prechal
- Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.,Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan Post
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ioanna Pechlivanidou
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ulrich Ronellenfitsch
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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39
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Salminen P, Mällinen J, Rautio T. Potential Benefit of Nonsurgical Management to Periappendicular Abscess-Reply. JAMA Surg 2019; 154:883-884. [PMID: 31166570 DOI: 10.1001/jamasurg.2019.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paulina Salminen
- Division of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Jari Mällinen
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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40
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Salminen P, Grönroos J, Rautio T. Complicated and Uncomplicated Acute Appendicitis Are Different Diseases-Do Not Compare Apples With Oranges. JAMA Surg 2019; 154:782-783. [PMID: 31042279 DOI: 10.1001/jamasurg.2019.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paulina Salminen
- Division of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Juha Grönroos
- Division of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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Prechal D, Damirov F, Grilli M, Ronellenfitsch U. Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:963-971. [PMID: 31004210 DOI: 10.1007/s00384-019-03296-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Appendectomy has been the gold standard for every form of appendicitis. In recent years, though, it has repeatedly been claimed that for acute uncomplicated appendicitis, antibiotic therapy can be an equivalent treatment. The aim of this meta-analysis was to determine if antibiotic therapy is a safe and effective alternative to appendectomy for acute uncomplicated appendicitis. METHODS In a systematic literature review, relevant databases were searched for randomized studies comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis. Two independent reviewers performed study selection and data extraction. The primary endpoint was the successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and the incidence of complications. RESULTS Five randomized controlled studies (n = 1430 patients) fulfilled the inclusion criteria. Of the 727 patients treated initially with antibiotics, 272 (37.4%) underwent secondary appendectomy within 1 year (treatment effectiveness: 62.6% compared to 96.3% in the surgical group, RR 0.65, 95% CI 0.55-0.76, p < 0.00001). Neither duration of hospital stay (MD 0.11 days, 95% CI: - 0.22-0.43, p = 0.53) nor the probability of complication-free treatment (RR 1.08, 95% CI: 0.97-1.22, p = 0.16) were significantly different between the two treatments. Absence from work was significantly shorter in the antibiotic group (MD - 2.49 days, 95% CI: - 4.59-- 0.40, p = 0.02). CONCLUSIONS This meta-analysis shows that appendectomy is more effective than antibiotic therapy for definitive cure of acute uncomplicated appendicitis. However, since the incidence of complications does not differ between the two treatments, antibiotic therapy might be a reasonable alternative for selected patients.
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Affiliation(s)
- Daniela Prechal
- Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Fuad Damirov
- Department of Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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