The association between appendicitis severity and patient age with appendiceal neoplasm histology—a population-based study

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.

Perforated Appendicitis

“…While patients that had surgery for uncomplicated appendicitis tend to attain quick recovery, usually within one or two days post-op, with limited chances of complications, particularly after having a laparoscopic appendectomy, some studies have shown that most PAp patients will 3/6 https://www.doi.org/10.53964/jmmi.2023001 have longer hospital stay and increased possibility of post-op complications [6] . Age has been reported to be directly linked to the severity of appendicitis complications [7] , as one study [8] showed that patients above 50 years old have higher risks of appendicitis complications, including perforation, abscess formation, and malignancy. In another retrospective study [4] of 1316 patients that underwent appendectomy, 83 of the 193 patients that had PAp were above 50 years old.…”

Five-year follow-up of appendiceal neoplasm risk in periappendicular abscess in the Peri-Appendicitis Acuta Randomized Clinical Trial

“…This long-term follow-up underlines the patient age as a major factor for an appendiceal tumor risk associated with a periappendicular abscess also demonstrated by the initial report1 and other studies. 5,6 The rate of appendiceal neoplasms needs to be validated by large prospective cohort studies to further define the necessity of interval appendectomy in all age groups.…”

“…Contemporary research shows alarming rates of appendiceal tumors associated with complicated acute appendicitis presenting as periappendicular abscess, and this risk is increased by patient age over 40 years. [1][2][3][4][5][6] The Peri-Appendicitis Acuta Randomized Clinical Trial (Peri-APPAC RCT) 1 comparing interval appendectomy and follow-up with magnetic resonance imaging (MRI) after the initial successful nonoperative treatment of periappendicular abscess was prematurely terminated in 2016 owing to ethical concerns due to high appendiceal neoplasm rate in the appendectomy group with final overall neoplasm prevalence of 20% (12/60). Out of the 30 patients randomized to MRI follow-up, appendectomy was recommended to all patients.…”

Appendiceal neoplasms—A practical guide

“…Reported rates of occult malignancy range from 2.3% to 12% in these patients. 8,11,[17][18][19][20] As such, patients with presumed appendicitis with an elevated risk of having an occult AN warrant colonoscopy as part of their evaluation, be it preoperatively or postoperatively. Patients who harbor AN are at an elevated risk of having synchronous neoplastic processes within their colon, with rates reported from 13% to 42%.…”

“…If nonoperative strategies are pursued to treat presumed appendicitis under these circumstances, the risk of having an occult malignancy and the role of interval appendectomy should be articulated in this discussion. Reported rates of occult malignancy range from 2.3% to 12% in these patients 8,11,17–20 . As such, patients with presumed appendicitis with an elevated risk of having an occult AN warrant colonoscopy as part of their evaluation, be it preoperatively or postoperatively.…”