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Is interval appendectomy really needed? A closer look at neoplasm rates in adult patients undergoing interval appendectomy after complicated appendicitis

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

The treatment algorithm for appendicitis is evolving, with recent interest in non-operative management. However, the safety of non-operative management for patients with complicated appendicitis has been questioned due to concern for increased risk of occult appendiceal neoplasm in this patient population. Our study aims to determine the rate of neoplasms discovered during interval appendectomy for patients with complicated appendicitis and determine the necessity of interval appendectomy.

Methods

A retrospective chart review was conducted on interval appendectomies performed in adult patients for complicated appendicitis at our institution over a 9-year period. Interval appendectomy was defined as appendectomy delayed from initial presentation with appendicitis. Complicated appendicitis was defined as perforation, phlegmon, and/or abscess as seen on computed tomography at time of presentation.

Results

We identified 402 patients who underwent interval appendectomy for complicated appendicitis. A total of 36 appendiceal neoplasms were discovered on final pathology with an overall neoplasm rate of 9%. Patients with an appendiceal neoplasm were significantly older (56.6 years vs 45.1 years, p < 0.01). No patients under the age of 30 had a neoplasm. The rate of appendiceal neoplasms in patients 30 years and older was 11%. The rate for patients 50 years and older was 16%. For patients 80 years and older, the rate of appendiceal neoplasm was 43%.

Conclusion

The risk of occult appendiceal neoplasm is low in patients under the age of 30; however, there was an 11% rate of appendiceal neoplasm in patients 30 years and older. The risk increases with increased age, with a 16% risk in patients 50 years and older. Given these findings, we recommend consideration of interval appendectomy in all patients 30 years and older with complicated appendicitis.

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Disclosures

Drs. Danielle Hayes, Shelby Reiter, MD, Gary Lucas, MD, Edward Hagen MD, Isabelle Chu MD, Tobias Muñiz MD1, and Ryan Martinez, MD have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Swedish Medical Center, Seattle, WA, USA

    Danielle Hayes, Shelby Reiter, Edard Hagen, Gary Lucas, Isabelle Chu, Tobias Muñiz & Ryan Martinez

  2. General Surgery Residency, Swedish Medical Center, 747 Broadway, Heath 10, Seattle, WA, 98122, USA

    Shelby Reiter

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  1. Danielle Hayes
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Correspondence to Shelby Reiter.

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Hayes, D., Reiter, S., Hagen, E. et al. Is interval appendectomy really needed? A closer look at neoplasm rates in adult patients undergoing interval appendectomy after complicated appendicitis. Surg Endosc 35, 3855–3860 (2021). https://doi.org/10.1007/s00464-020-07798-9

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