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Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

2020; Elsevier BV; Volume: 168; Issue: 4 Linguagem: Inglês

10.1016/j.surg.2020.05.044

1532-7361

Leon Naar, Peter S. Kim, Saskya Byerly, Georgia Vasileiou, Hang Zhang, D. Dante Yeh, Haytham M.A. Kaafarani, Reginald Alouidor, Kailyn Kwong Hing, Victoria Sharp, Thomas E. Serena, Stacie L. Allmond, Bruce Long, Nadine Barth, Janika San Roman, Ryan A. Lawless, Alexis Cralley, Rondi B. Gelbard, Crystal Szczepanski, Steven D. Eyer, Kaitlyn Proulx, Jeffrey Wild, Katelyn Young, Erik J. Teicher, Elena Lita, David S. Morris, Laura Juarez, Richard D. Catalano, David Turay, Daniel C. Cullinane, Jennifer Roberts, Ahmed Eid, Mohamed D. Ray-Zack, Tala Kanaan, Victor Portillo, Morgan Collom, Christopher Dodgion, Savo Bou Zein Eddine, Maryam B. Tabrizi, Ahmed Elsayed Mohammed Elsharkawy, David Evans, Daniel Vázquez, Jonathan M. Saxe, Lewis E. Jacobson, Brandon Behrens, Martin Schreiber, Bellal Joseph, Muhammad Zeeshan, Jeffry Nahmias, Beatrice J. Sun, Marie Crandall, Jennifer Mull, Jason Pasley, Lindsay O’Meara, Ali Gök, Jocelyn To, Carlos Rodríguez, Matthew Bradley,

Hernia repair and management

Abstract Background The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy. Methods Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit. Results A total of 3,293 patients were included. The median age was 38 (27–53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5–67] vs 37 [27–52] years, P < .001), had longer duration of symptoms before presentation (36–41 vs 18–23 hours, P = .03), and were more likely to have a phlegmon on imaging (6.3% vs 1.3%, P = .03). Multivariable analyses showed that an enlarged appendiceal diameter was independently associated with malignancy (odds ratio = 1.06, 95% confidence interval = 1.01–1.12; P = .01). The incidence of malignancy in patients >40 years with an appendiceal diameter >10 mm on computed tomography was 2.95% compared with 0.97% in patients ≤40 years old with appendiceal diameter ≤10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24–7.42; P = .02). Conclusion The combination of age >40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis.