Increased risk of neoplasm in appendicitis treated w... [Am Surg. 2012] - PubMed - NCBI
Increased
risk of neoplasm in appendicitis treated with interval appendectomy:
single-institution experience and literature
Abstract
Appendicitis
is a common diagnosis encountered by the acute care surgeon. Management
of complicated appendicitis is controversial and often involves initial
nonoperative therapy with interval appendectomy. This study reviews
single-institutional experience with management of complicated
appendicitis with interval appendectomy and addresses an unusually high
occurrence of incidental appendiceal malignancies observed with a review
of relevant literature. A retrospective review of all diagnoses of
appendicitis was performed over 5 years at a tertiary care center.
Patient demographics, time to surgery, operative technique, pathologic
diagnosis, and clinical outcomes were examined. Three hundred fifteen
patients were diagnosed with acute appendicitis. Of these, 24 (7.6%)
were deemed complicated and did not undergo immediate appendectomy, and
18 ultimately underwent appendectomy at our institution and were
included in analysis. There were no statistical demographic or
symptomatic differences between the immediate and interval appendectomy
patients. Ninety-nine per cent of the immediate appendectomy patients
were treated laparoscopically; 78 per cent of the interval group
underwent attempted laparoscopic treatment with 56 per cent completed
without conversion to open (P < 0.01). Neoplasms were discovered in 1
per cent of the acute appendectomy group and 28 per cent of the
interval appendectomy group (P < 0.0001). Two of the three neoplasms
in the acute group were carcinoid, whereas three of the five neoplasms
in the interval group were adenocarcinoma. Surgeons should consider
appendiceal or colonic neoplasms in cases of complicated appendicitis
when nonoperative management is considered. This is most important in
patients older than 40 years, in those who forego interval
appendectomy, or in those who could be lost to follow-up.
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