The Prevalence of Malignant Tumors of the Appendix in Patients with a History of Appendectomy and its Association with Demographic and Laboratory Variables
Citation Information :
Makhsosi BR, Darabi F, Mazaheri T, Rezaei M, Mazaheri Z, Rohban A. The Prevalence of Malignant Tumors of the Appendix in Patients with a History of Appendectomy and its Association with Demographic and Laboratory Variables. World J Lap Surg 2022; 15 (3):235-238.
Aim: Appendicitis is one of the major causes of acute abdominal pain and one of the most common reasons for emergency surgery. Studies have shown that those that have undergone appendectomy are more likely to develop malignant tumors of the appendix. The present study investigates the prevalence of the appendix's malignant tumors in patients with a history of appendectomy and its association with demographic and laboratory variables.
Materials and methods: This study is descriptive, in which 4940 patients with a history of appendectomy between 2011 and 2018 in Imam Reza Hospital, Kermanshah, Iran, have been studied. Initially, the patients’ medical files were investigated, and the necessary demographic and laboratory information were extracted. Then, the data were analyzed by descriptive statistics, including mean and variance for quantitative variables and frequency/percentage plus two-dimensional contingency tables for qualitative variables by SPSS 21.
Results: The mean age of the patients with appendectomy was 25.50 years, and the prevalence of malignant tumors of the appendix in patients was 0.5%. Overall, 41 cases (0.8%) showed positive pathology regarding the existence of a tumor in the appendix; among them, 26 cases (0.5%) had malignant types, while 15 cases (0.3%) showed benign types. Out of the 26 cases with the appendix's malignant tumors, 14 were male (53.8%), and 12 were female (46.2%). The majority of malignant tumors of the appendix were observed in those above 50 years of age. Among the malignant tumors, 9 (34.61%) were adenocarcinoma mucinous, 6 (23.07%) were carcinoid, 5 (19.23%) were adenocarcinoma, 5 (19.23%) were malignant mucocele, and 1 (3.84%) was cystadenoma. The relationship between the number of white blood cells (WBC) and the appendix's malignant tumors was significant; the WBC count was significantly lower in those with malignant tumors compared to others. In addition, the relationship between age and the existence of malignant tumors was significant (p = 0.025); older individuals were significantly more likely to develop malignant tumors of the appendix compared with younger individuals. The study results did not show any significant relationship between gender and the presence of malignant tumors of the appendix (p = 0.340).
Conclusion: Concerning the local invasion and distant metastasis of some appendix tumors, follow-up of pathology reports by the patient (especially older ones) as well as the physician plus post-appendectomy checkup within short and regular time intervals and, if required, follow-up treatment is essential.
Kooij I, Sahami S, Meijer S, et al. The immunology of the vermiform appendix: a review of the literature. Clin Exp Immunol 2016;186(1):1–9. DOI: 10.1111/cei.12821.
Gebbers JO, Laissue JA. Bacterial translocation in the normal human appendix parallels the development of the local immune system. Ann N Y Acad Sci 2004;1029:337–343. DOI: 10.1196/annals.1309.015.
van Rossem CC, Bolmers MDM, Schreinemacher MHF, et al. Diagnosing acute appendicitis: surgery or imaging? Colorectal Dis 2016;18(12):1129–1132. DOI: 10.1111/codi.13470.
Georgiou R, Eaton S, Stanton MP, et al. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics 2017;139(3):e20163003. DOI: 10.1542/peds.2016-3003.
Guthery SL, Hutchings C, Dean JM, et al. National estimates of hospital utilization by children with gastrointestinal disorders: analysis of the 1997 kids’ inpatient database. J Pediatr 2004;144(5):589–594. DOI: 10.1016/j.jpeds.2004.02.029.
Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002;137(7):799–804. DOI: 10.1001/archsurg.137.7.799.
Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(5):910–925. DOI: 10.1093/oxfordjournals.aje.a115734.
Alemayehu H, Snyder CL, Peter SDS, et al. Incidence and outcomes of unexpected pathology findings after appendectomy. J Pediatr Surg 2014;49(9):1390–1393. DOI: 10.1016/j.jpedsurg.2014.01.005.
Harnoss JC, Zelienka I, Probst P, et al. Antibiotics versus surgical therapy for uncomplicated appendicitis: systematic review and meta-analysis of controlled trials (PROSPERO 2015: CRD42015016882). Ann Surg 2017;265(5):889–900. DOI: 10.1097/SLA.0000000000002039.
Montravers P, Dupont H, Leone M, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med 2015;34(2):117–130. DOI: 10.1016/j.accpm.2015.03.005.
Karanikas M, Kofina K, Markou M, et al. Acute appendicitis as the first presentation of appendiceal metastasis of gastric cancer—report of a rare case. J Surg Case Rep 2018;2018(8):rjy208. DOI: 10.1093/jscr/rjy208.
Kelly KJ. Management of appendix cancer. Clin Colon Rectal Surg 2015;28(4):247–255. DOI: 10.1055/s-0035-1564433.
Tchana-Sato V, Detry O, Polus M, et al. Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol 2006;12(41):6699–6701. DOI: 10.3748/wjg.v12.i41.6699.
Deshmukh S, Verde F, Johnson PT, et al. Anatomical variants and pathologies of the vermix. Emerg Radiol 2014;21(5):543–552. DOI: 10.1007/s10140-014-1206-4.
Ruoff C, Hanna L, Zhi W, et al. Cancers of the appendix: Review of the literatures. ISRN Oncol 2011;2011:728579. DOI: 10.5402/2011/728579.
Horton KM, Kamel I, Hofmann L, et al. Carcinoid tumors of the small bowel: A multitechnique imaging approach. Am J Roentgenol 2004;182(3):559–567. DOI: 10.2214/ajr.182.3.1820559.
McCusker ME, Coté TR, Clegg LX, et al. Primary malignant neoplasms of the appendix: A population‐based study from the surveillance, epidemiology and end‐results program, 1973–1998. Cancer 2002;94(12):3307–3312. DOI: 10.1002/cncr.10589.
Khan SA, Khokhar HA, Nasr A, et al. Incidence of right-sided colonic tumors (non-appendiceal) in patient's ≥40 years of age presenting with features of acute appendicitis. Int J Surg 2013;11(4):301–304. DOI: 10.1016/j.ijsu.2013.02.004.
Chinifroush M, Mohajeri S, Shirinzadeh B. The prevalence of appendix carcinoid in appendectomized patients Fatemi Hospital in Ardabil. J Ardabil Univ Med Sci 2008;8(3):241–245.
Vessal P, Ahmadian Moghaddam H, Vahidi S. Prevalence of carcinoid tumor in appendectomy specimens in hospitals affiliated to Shaheed Beheshti University of Medical Sciences. Iran J Endocrinol Metab 2000;2(3):197–202.
Guraya SY, Khairy GA, Ghallab A, et al. Carcinoid tumors of the appendix. Our experience in a university hospital. Saudi Med J 2005;26(3):434–437. PMID: 15806214.
Ahmadi Nejad M, Saki M, Azizi M. Study of frequency and Prognosis of appendix carcinoid tumor in appendoctomies done in Shohada hospital in Khorramabad. Yafteh 2010;11(4):5–10.
Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer 1997;79(4):813–829. DOI: 10.1002/(sici)1097-0142(19970215)79:4<813::aid-cncr19>3.0.co;2-2.
Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med 1999;340(11):858–868. DOI: 10.1056/NEJM199903183401107.
Sandor A, Modlin IM. A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol 1998;93(3):422–428. DOI: 10.1111/j.1572-0241.1998.00422.x.
Birchley D. Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays. Ann R Coll Surg Engl 2006;88(1):27–32. DOI: 10.1308/003588406X83041.
Kessler N, Cyteval C, Gallix Bt, et al. Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology 2004;230(2):472–478. DOI: 10.1148/radiol.2302021520.