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Original Investigation |

Increased Risk of Mucinous Neoplasm of the Appendix in Adults Undergoing Interval Appendectomy

Matthew J. Furman, MD2; Mitchell Cahan, MD2; Philip Cohen, MD2; Laura A. Lambert, MD1
[+] Author Affiliations
1Division of Surgical Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
2Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts
JAMA Surg. 2013;148(8):703-706. doi:10.1001/jamasurg.2013.1212.
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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.

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Pathologic Findings in Patients Who Underwent Immediate (n = 359) vs Interval (n = 17) Appendectomy
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Submit a Comment
when the appendix is more than inflamed.
Posted on June 6, 2013
basil b fadipe
justin fadipe centre. dominica. West Indies
Conflict of Interest: None Declared
This study, small sample evidence as it is, is a welcome alert to revise prevailing instinct that assumes appendicitis always has an inflammatory basis. Though by far the dominant affliction of the clinical appendix is primary inflammation, there are secondary drivers of the inflammation from time to time including midgut carcinoids that should persuade towards removing a clinical appendix as a primary or secondary(interval) procedure.
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