Prevalence of Carcinoma in Appendectomy Specimens for Patients Presenting With Acute Appendicitis: A Single-Center Study

Abstract

Introduction Acute appendicitis is the most common general surgical emergency globally. Its etiology includes the presence of luminal obstruction by faecoliths, lymphoid hyperplasia, impacted stool, and rarely by appendiceal or caecal cancer. Malignancy related to acute appendicitis is usually seen in the older age group. Aim To identify the subset rate of patients operated for acute appendicitis who have appendiceal carcinoma and analyze the outcome of their post-operative management. Material and methods A retrospective study of a cohort of 529 patients aged > 40 diagnosed with acute appendicitis with subsequent appendectomy in the period between 1 January 2014 and 31 December 2019 at Basildon and Thurrock University Hospital, Essex, United Kingdom was conducted. We analyzed the clinical data of the cohort including demographic information, diagnosis, pre-operative imaging, histological diagnosis as well as post-operative management where indicated. Results The median age of patients was 54.5 years (range 40-92). The male to female ratio in the appendicectomy cohort was 1:1.1. About 45% were aged 40-49 years, 24.8% were aged 50-59 and 30.2% were ≥60 years. Post-operative histology revealed acute appendicitis in 82.4% of the group. In 11% of the patients, the histology revealed the presence of other benign pathology as mucocele of the appendix, acute diverticulitis, follicular hyperplasia, and fibrous obliteration. The diagnosis of appendicular malignancy was seen in 1.9%. Conclusion Incidental appendiceal cancers in the resected specimens after acute appendicitis are rare but may be associated with a poor prognosis. It is recommended to consider such diagnosis in particular when dealing with acute appendicitis in older patients with longer symptom history, and in presence of peri-appendicular mass.

Risk of colorectal cancer in patients with appendicitis over the age of 40 years

“…The rate of appendiceal malignancy (including adenocarcinoma and carcinoid) seen was comparable to the available literature [23, 24]. However, there is clinically less ambiguity about undertaking luminal investigation in this group as most will undergo a colonoscopy after histology has confirmed a neoplastic lesion.…”

Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy

“…Historically, the most common primary appendiceal tumor diagnosed after appendectomy for appendicitis was a carcinoid in 60%-85%, with epithelial appendix neoplasms in about 20%-40%. 1 In this series, epithelial tumors have been found more frequently than neuroendocrine tumors. We hypothesize that epithelial tumors of the appendix may be more common in patients with a primary colorectal cancer.…”

“…Appendix neoplasms seem to be rare, and the age-adjusted incidence is 0.12 cases per one million people per year. 1,2 Approximately 50% of appendix neoplasms manifest as acute appendicitis, being more frequent in patients who present with an appendix mass. [3][4][5][6] The remainder are found incidentally at radiological imaging, during laparotomy or laparoscopy for other abdominal pathology, or accidentally in prophylactic appendectomy specimens.…”

“…4 Historically, the most common primary appendiceal tumor diagnosed after appendectomy for appendicitis was carcinoid in up to 85%. 1 The current study involves prophylactic appendectomy in patients with known colorectal cancer undergoing surgical resection. Prophylactic appendectomy is defined as the removal of a macroscopically normal vermiform appendix whilst performing another abdominal operation.…”

Prevalence of Neuroendocrine Tumours (NET) in Patients Undergoing Appendicectomy for Acute Appendicitis: A Tertiary Care Study

“…The lumen blockage leads to increased intramural pressure, affecting venous and lymphatic outflow and impaired blood flow and ischemia. The inflammatory process can result in perforation, abscess formation, and generalized peritonitis [ 5 ].…”