Appendicitis as an Early Manifestation of Subsequent Malignancy: An Asian Population Study

Abstract

Background & AimsCancer risk after appendectomy in patients with appendicitis remains unclear. This study examined the role of appendicitis as an early manifestation harbingering the distant malignancy.MethodsFrom the insurance claims data of Taiwan, we identified a cohort of 130,374 patients newly received appendectomy from 2000–2009, without cancer diagnosis. A comparison cohort of 260,746 persons without appendectomy and cancer was selected from the same database, frequency matched by age, sex, comorbidity and index year. We monitored subsequent cancers with a12-month follow-up.ResultsOver all, 1406 and 616 cancer cases were identified in the appendectomy cohort and comparisons, respectively, with all cancers incidence rate 4.64-fold higher in the appendectomy cohort (9.06 vs. 1.96 per 1000 person-months). Digestive and female genital organs harbored 80.9% of cancer cases in the appendectomy cohort. The Cox model measured site-specific hazard ratio (HR) was the highest for female genital cancers (23.3), followed by cancers of colorectum (14.7), small intestine (10.1), pancreas (7.40), lymphoma (5.89) and urinary system (4.50), all significant at 0.001 level. The HR of all cancers decreased from 13.7 within 3 months after appendectomy to 1.37 in 7–12 months after the surgery. In general, relative to the comparison cohort, younger appendectomy patients tended to have a higher HR than older patients.ConclusionsThe high incident cancers identified soon after appendectomy suggest the acute appendicitis is the early sign of distant metastatic malignancy. The risk of colorectal cancer, female genital cancer and haemopoietic malignancy deserve attention.

The Risk of Colorectal Cancer After Cholecystectomy or Appendectomy: A Population-based Cohort Study in Korea

“…This result might imply that appendicitis, the reason for appendectomy, could be an early sign of CRC, which has also been shown in other studies. The studies conducted by Wu and Colleagues [25,26] reported that the risk tended to be elevated in shorter follow-up periods.…”

Long-Term Complications of Appendectomy: A Systematic Review

“…Six retrospective studies focused on cancer (20,21,24,25,46,51). The studies had a median bias assessment score of seven (range, 5-8) stars, a median follow-up time of 12.6 (range, 1-18.6) years, and a median population of (24,25). A study with follow-up ranging from 0 to 12 months found an HR on all types of cancers of 4.6 (99.9% CI: 3.81-5.55) in favor of the control group (24).…”

“…The studies had a median bias assessment score of seven (range, 5-8) stars, a median follow-up time of 12.6 (range, 1-18.6) years, and a median population of (24,25). A study with follow-up ranging from 0 to 12 months found an HR on all types of cancers of 4.6 (99.9% CI: 3.81-5.55) in favor of the control group (24). Another study with a follow-up period of 15 years (thus excluding the first 18 months) found an HR of colorectal cancers of 1.14 (95% CI: 1.02-1.28) in favor of the control group (25).…”

Are we any closer to screening for colorectal cancer using microbial markers?A critical review

“…55 ). Similarly, appendicitis and appendectomy have been linked to increased risk of CRC and female genital organ cancer in a relatively short period after surgery, indicating appendicitis to be an early marker of distant tumour proliferation 56,57 . Although these data come from an Asian population, it would be reasonable to offer primary screening colonoscopy to a patient who has undergone appendectomy.…”