Increased risk of mucinous neoplasm of the appendix in adults undergoing interval appendectomy

JAMA Surg. 2013 Aug;148(8):703-6. doi: 10.1001/jamasurg.2013.1212.

Abstract

Importance: The role of interval appendectomy after conservative management of perforated appendicitis remains controversial. Determining the etiology of perforated appendicitis is one reason to perform interval appendectomies.

Objective: To determine whether adult patients undergoing interval appendectomy experience an increased rate of neoplasms.

Design: Retrospective study.

Setting: A single tertiary care institution.

Participants: All patients 18 years or older who underwent appendectomy for presumed appendicitis from January 1, 2006, through December 31, 2010. EXPOSURES Appendectomy for presumed appendicitis.

Main outcomes and measures: Underlying neoplasm as the cause of presentation for presumed appendicitis. Demographic data, clinicopathologic characteristics, interval resection rate, and complication data were collected and analyzed.

Results: During the study period, 376 patients underwent appendectomies. Interval appendectomy was performed in 17 patients (4.5%). Neoplasms were identified in 14 patients (3.7%); 5 of those tumors occurred in patients who had undergone interval appendectomy (29.4%). Nine neoplasms were mucinous tumors (64.3%), including all neoplasms associated with interval appendectomies. The mean age of all patients with appendiceal tumors was 49 years (range, 35-74 years).

Conclusions and relevance: Mucinous neoplasms of the appendix were found in 5 of 17 patients (29.4%) undergoing interval appendectomy. Interval appendectomies should be considered in all adult patients, especially those 40 years or older, to determine the underlying cause of appendicitis. A multi-institutional study to determine the generalizability of these findings is warranted.

MeSH terms

  • Adenocarcinoma, Mucinous / epidemiology*
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / surgery
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Appendectomy*
  • Appendiceal Neoplasms / epidemiology*
  • Appendiceal Neoplasms / pathology*
  • Appendiceal Neoplasms / surgery
  • Appendicitis / etiology
  • Appendicitis / pathology
  • Appendicitis / surgery*
  • Carcinoid Tumor / epidemiology
  • Carcinoid Tumor / pathology
  • Carcinoid Tumor / surgery
  • Cystadenoma, Mucinous / epidemiology*
  • Cystadenoma, Mucinous / pathology
  • Cystadenoma, Mucinous / surgery
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Young Adult