A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

Park, Youn Young; Lee, Kil-Yong; Oh, Seong Taek; Park, Sang Hyun; Han, Kyung Do; Lee, Jae Im

doi:10.1038/s41598-020-72770-5

Cited by 10 publications

(8 citation statements)

References 41 publications

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“…The cohort with appendicitis was shifted to younger ages, producing an expected count of 3.35 cases and a standardized incidence ratio (SIR) of 3.28 with a 95% CI of 1.82-5.92. This is generally consistent with the majority of the existing literature (summarized in Table S3), which suggests that older patients presenting with appendicitis have an increased risk of bowel cancer in the first few years after appendicectomy [9,10,12,15,16]. Two large population-based studies suggest the risk is around double that of the age-standardized background population [9,12].…”

Section: Incidencesupporting

confidence: 88%

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Risk of colorectal cancer in patients with appendicitis over the age of 40 years

et al. 2022

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Aim Acute appendicitis in late adulthood is hypothesized to be associated with an increased risk of colorectal cancer (CRC). This study aimed to establish whether patients over the age of 40 years presenting with appendicitis had an increased risk of being diagnosed with CRC over the subsequent 3 years. Method This is a retrospective review of patients aged 40 years and over presenting to Canterbury District Health Board with appendicitis from January 2010 to December 2015. Clinical details were obtained for these patients and cross‐referenced with the New Zealand Cancer Registry for the 3 years following diagnosis. The incidence ratio rate (IRR) and standardized incidence ratio (SIR) were calculated by establishing the incidence of CRC in this cohort and comparing it with the Canterbury population data. Results A total of 1099 patients met the inclusion criteria. The majority (75%) underwent CT as part of their initial work‐up. The rate of colonoscopy increased with age from around 10% between 40 and 49 years to 27% for those 70 years and over. Eleven cases of CRC were identified, resulting in an IRR 2.35 (95% CI 1.17–4.21). The SIR for this population was 3.28 (95% CI 1.82–5.92). Conclusion The rate of CRC is significantly increased compared with the background population in this cohort. The results of this study support luminal investigation of adults aged 40 years and over who present with acute appendicitis as CT alone was insufficient to detect the pathology.

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Section: Incidencesupporting

confidence: 88%

“…There has also been discordance in the literature regarding the actual risk of CRC after appendicitis. A number of retrospective series have suggested an increased risk of CRC in older patients with appendicitis [6][7][8][9][10]; however, other studies have shown no difference [11] or implied that any difference may be artefactual [12].…”

Section: Introductionmentioning

confidence: 99%

Risk of colorectal cancer in patients with appendicitis over the age of 40 years

et al. 2022

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“…Seven of them noticed a significantly higher CRC risk in the appendectomy group 18,21,23,24,28,32,33 while seven established no difference between the risk of CRC in patients with or without appendectomy. 13,16,19,22,31,34,35 One of them even observed that appendectomy might be a protective factor for CRC. 30 Detailed results are available in Table S2.…”

Section: Resultsmentioning

confidence: 99%

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Liu

Zhu

et al. 2023

J of Gastro and Hepatol

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Background and Aim Appendectomy is associated with various diseases, but whether it increases the risk of colorectal cancer (CRC) remains uncertain. We conducted a systematic review and meta‐analysis aimed at investigating the suggested correlation between appendectomy and CRC. Methods Systematic retrieval was performed using the PubMed, Embase, Cochrane library, Web of Science, and http://ClinicalTrials.gov databases up to May 4, 2022, for studies reported the influence of appendectomy on CRC, colon cancer (CC) or rectal cancer (RC). Odd ratios (ORs) and 95% confidence intervals (CIs) of CRC after appendectomy were pooled using the random effects model. Subgroup analyses were carried on by region, sex, and tumor location. Results Our search identified 1743 articles, of which 22 studies from three continents published between 1964 and 2022 were eligible for inclusion. Overall, people with appendectomy had a higher risk of CRC (OR = 1.31; 95% CI [1.05, 1.62]). But the risk for Europeans was not significant (OR = 0.94; 95% CI [0.87, 1.02]; I2 = 0%), while for Americans and Asians, appendectomy would increase the risk of CRC (OR = 1.68; 95% CI [1.15, 2.44]; I2 = 65% and OR = 1.46; 95% CI [1.04, 2.05]; I2 = 98%), especially in females and in developing countries. It is worth noting that appendectomy might be a protective factor for CC in European women (OR = 0.87; 95% CI [0.77, 0.98]; I2 = 0%). Conclusions Appendectomy may be a risk factor for CRC, with varying degrees in different populations. More high‐quality cross‐regional studies are needed for better clinical decision making.

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“…Additionally, inflammatory responses are not only of interest during appendicitis. The appendix has been associated with multiple diseases, including colorectal cancer, ulcerative colitis, and Parkinson's disease, although via mechanisms unknown [44][45][46][47][48] . Additional research regarding the environment of the human appendix may reveal new insights into both the function of this organ as well as insights into the pathophysiology of multiple human diseases.…”

Section: Discussionmentioning

confidence: 99%

Germinal center BCR maturation in appendicitis reveals a role for antigen-specific adaptive immune responses during disease

Stewart,

Taghvaei,

Leon

et al. 2024

Preprint

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Appendicitis is one of the most common abdominal emergencies globally, yet little is understood about the inflammatory mechanisms or potential drivers of disease. Neutrophil inflammation and increased cytokine expression such as IL-6 and IL-8 are hallmarks of appendicitis inflammation. However, early histological studies identified increased T and B cell infiltration during appendicitis, providing support for adaptive immune activation as well, although this has never been investigated in depth. We hypothesized that antigen-dependent activation of the adaptive immune response contributes to appendicitis pathology, in addition to the known innate-mediated processes. Via a series of transcriptomic approaches and lymphocyte repertoire analysis in human appendiceal tissue, we identified evidence of antigen-dependent B cell activation. Increased somatic hypermutation in the germinal center and plasma cell compartment was comprised of presumed high-affinity IgG and IgA B cells. We propose that the appendiceal microbiome acts as a source of antigen, as significant microbial dysbiosis was observed during appendicitis. This dysbiosis was characterized by outgrowth of pathobionts such as Parvimonas and oral biofilm-formers such as Fretibacterium and Fusobacterium, in line with previous reports. We also identified potential loss of epithelial barrier integrity via spatial transcriptomic analysis of the appendiceal epithelium, supporting the possibility of microbial invasion into the tissue during appendicitis. This study provides insight into the inflammatory mechanisms of a common disease and helps to define the immune and microbial compartment of an often-ignored organ, the appendix.

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A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

Cited by 10 publications

References 41 publications

Risk of colorectal cancer in patients with appendicitis over the age of 40 years

Risk of colorectal cancer in patients with appendicitis over the age of 40 years

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Germinal center BCR maturation in appendicitis reveals a role for antigen-specific adaptive immune responses during disease

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