Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?

Şevki Pedük

doi:10.58600/eurjther1977

Authors

Şevki Pedük Department of Surgical Oncology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey https://orcid.org/0000-0002-7476-384X

DOI:

https://doi.org/10.58600/eurjther1977

Keywords:

Appendicitis, Appendectomy, Appendiceal Neoplasms, Appendiceal Tumor

Abstract

Objective: The detection of malignancy in the final pathology report of patients undergoing surgery for acute appendicitis is a nasty surprise for both the patient and the clinician. To improve the management of this situation, we analyzed clues for predicting possible neoplasms.

Methods: We analyzed in detail the data of patients operated on in our department with a preliminary diagnosis of acute appendicitis over 42 months. The group whose final pathology was reported as primary appendiceal neoplasm was compared with the acute appendicitis group.

Results: Appendiceal neoplasm was detected in 16 patients (1%). Half of these were mucinous epithelial neoplasms. Neuroendocrine tumors (18.7%) were the second most common neoplasm. According to the logistic regression model, low hemoglobin level (p<0.01) and low Alvarado score (p:0.02) were the two most valuable factors in the prediction of primary appendiceal neoplasms. Laboratory findings of high neutrophil/lymphocyte ratio (p<0.01) and plastron formation on imaging (p:0.03) were more common in the neoplasm group. Advanced age, comorbidity, immunosuppression and inflammatory bowel diseases (IBD) were other characteristics of the neoplasm group.

Conclusions: Appendiceal neoplasms should always be considered in anemic patients with relatively low Alvarado scores.

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References

Shaib WL, Assi R, Shamseddine A, Alese OB, Staley C 3rd, Memis B, Adsay V, Bekaii-Saab T, El-Rayes BF (2016) Appendiceal Mucinous Neoplasms: Diagnosis and Management. Oncologist 9:1107-1116. https://doi.org/10.1634/theoncologist.2017-0081

Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 41:75–80. https://doi.org/10.1007/BF02236899

Carpenter SG, Chapital AB, Merritt MV, Johnson DJ (2012) Increased risk of neoplasm in appendicitis treated with interval appendectomy: single-institution experience and literature review. Am Surg 78:339-43

Bardakci M, Demirtas Esmer D, Hafızoğlu E, Karakaş H, Bal Ö, Algın E, Akıncı MB, Yalçın B (2023) Clinical Presentation and Prognostic Factors of Primary Appendiceal Malignancies: A retrospective evaluation. Adnan Menderes University Journal of Faculty of Health Sciences 7:296-304. https://doi.org/10.46237/amusbfd.1098489

McCusker ME, Coté TR, Clegg LX, Sobin LH (2002). Primary malignant neoplasms of the appendix: A population-based study from the surveillance, epidemiology and end-results program, 1973-1998. Cancer 94:3307-3312. https://doi.org/10.1002/cncr.10589

Zakka K, Williamson S, Jiang R, Reid MD, Alese OB, Shaib WL, Wu C, Behera M, El-Rayes BF, Akce M (2021) Is adjuvant chemotherapy beneficial for stage II-III goblet cell carcinoid/goblet cell adenocarcinoma of the appendix? Surg Oncol 36:120-129. https://doi.org/10.1016/j.suronc.2020.12.003

Son J, Park YJ, Lee SR, Kim HO, Jung KU (2020) Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy. Ann Coloproctol 36:311-315. https://doi.org/10.3393/ac.2019.10.15.1

Tabachnick BG, Fidell LS (2007) Experimental designs using ANOVA (Vol. 724). Belmont, CA: Thomson/Brooks/Cole

Turan Ü, Kılavuz H, Irkorucu O (2022) Emergency Right Hemicolectomy for Pericecal Masses Mimicking Acute Appendicitis: Surgeon’s Fearful Dilemma. Eur J Ther 28:142-145. https://doi.org/10.54614/eurjther.2021.0090

Kelly KJ (2015) Management of Appendix Cancer. Clin Colon Rectal Surg. 28:247-55. https://doi.org/10.1055/s-0035-1564433

Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 132:910–25. https://doi.org/10.1093/oxfordjournals.aje.a115734

Loftus TJ, Raymond SL, Sarosi GA Jr, Croft CA, Smith RS, Efron PA, Moore FA, Brakenridge SC, Mohr AM, Jordan JR (2017) Predicting appendiceal tumors among patients with appendicitis. J Trauma Acute Care Surg. 82:771-775. https://doi.org/10.1097/TA.0000000000001378

Sadot E, Keidar A, Shapiro R, Wasserberg N (2013) Laparoscopic accuracy in prediction of appendiceal pathology: oncologic and inflammatory aspects. Am J Surg. 206:805-9. https://doi.org/10.1016/j.amjsurg.2013.05.002

Yıldırım E, Kegin M, Özdemir M, Bektaş S, Pelen Z, Er M (2022) Neoplasms of the appendix: Single institution and ten-year experiences results. Ulus Travma Acil Cerrahi Derg. 28:352-360. https://doi.org/10.14744/tjtes.2021.86032

Greenstein AJ, Balasubramanian S, Harpaz N, Rizwan M, Sachar DB (1997) Carcinoid tumor and inflammatory bowel disease: a study of eleven cases and review of the literature. Am J Gastroenterol. 92:682-5

Le Marc'hadour F, Bost F, Peoc'h M, Roux JJ, Pasquier D, Pasquier B (1994) Carcinoid tumour complicating inflammatory bowel disease. A study of two cases with review of the literature. Pathol Res Pract. 190:1185-92. https://doi.org/10.1016/S0344-0338(11)80445-0

Da Silva JIA, Caetano C, da Rocha AMS, Lamas NJ, Lago P, Pedroto IMTC (2020) A rare cecal subepithelial tumor in a Crohn´s Disease patient. Autops Case Rep. 8;11:e2020211. https://doi.org/10.4322/acr.2020.211

Nehme F, Schneider A, Hamid F (2019) Appendiceal Adenocarcinoma Associated With Ulcerative Colitis. ACG Case Rep J. 25;6:e00255. https://doi.org/10.14309/crj.0000000000000255

Marotta B, Chaudhry S, McNaught A, Quereshy F, Vajpeyi R, Chetty R, Ghai S (2019) Predicting Underlying Neoplasms in Appendiceal Mucoceles at CT: Focal Versus Diffuse Luminal Dilatation. AJR Am J Roentgenol. 213:343-348. https://doi.org/10.2214/AJR.18.20562

Koç MA, Çelik SU (2023) Evaluation of factors predicting appendiceal tumoral lesions in patients undergoing appendectomy for acute appendicitis. Ulus Travma Acil Cerrahi Derg. 29:358-363. https://doi.org/10.14744/tjtes.2023.34833