Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis is Associated with Older Age – A Retrospective Cohort Study

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 as a primary therapy. Appendiceal neoplasms are found rarely and often as an incidental finding in the setting of appendectomy for acute appendicitis. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies.Methods: We reviewed electronic medical records for a nine-year period (2010-2018) of patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City. The authors also examined patients undergoing appendectomy during the same time interval through a query of the National Surgical Quality Improvement Program (NSQIP) database. Results: We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in available 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: We submit that the management of acute appendicitis involves a consideration of appendiceal neoplasm in patients over the age of 40. This should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy. If this is undertaken, interval appendectomy or further cancer screening and surveillance should be performed.