Is interval appendectomy indicated after non-operative management of acute appendicitis in patients with cancer? A retrospective review from a single institution

Tushar Samdani, Tiffany T. Fancher, Frederic M. Pieracci, Soumitra Eachempati, Laila Rashidi, Garrett M. Nash

Research output: Contribution to journalArticle

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Abstract

Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed nonoperatively (NOM) during index hospitalization (IHA) for acute appendicitis (AA). Clinical presentation, cancer treatment, and follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between August 1999 and August 2009. Seventy-two of 109 AA patients underwent appendectomy during IHA; 34 of these 109 wereNOMduring IHA.Median index length ofNOMpatients' stay was six days (0-55), median age was 59 (18-80) years. Indications for NOM were presence of abscess or phlegmon (14),mild symptoms (13), high surgical risk (3), end-stage cancer (3), and patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of intravenous 1 oral antibiotics 5 12 days [0-55]). There were six deaths (1 IHA, 5 NOM): four sepsis and two cancer progression. At a median of 19-month follow-up (range 1-103), four NOMpatients surviving IHA had recurrent AA (11.7%) at two (n 5 2) and three months (n 5 2) after the first episode. Overall, six had IA (17.6%) one to seven months post AA; 25 remained asymptomatic, without IA. In conclusion, among NOM patients at a cancer center at IHA for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up.

Original languageEnglish (US)
Pages (from-to)532-536
Number of pages5
JournalAmerican Surgeon
Volume81
Issue number5
StatePublished - Jan 1 2015

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Appendectomy
Appendicitis
Hospitalization
Neoplasms
Abdominal Abscess
Cellulitis
Electronic Health Records
Abscess
Drainage
Length of Stay
Sepsis
Anti-Bacterial Agents
Therapeutics

ASJC Scopus subject areas

  • Surgery

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Is interval appendectomy indicated after non-operative management of acute appendicitis in patients with cancer? A retrospective review from a single institution. / Samdani, Tushar; Fancher, Tiffany T.; Pieracci, Frederic M.; Eachempati, Soumitra; Rashidi, Laila; Nash, Garrett M.

In: American Surgeon, Vol. 81, No. 5, 01.01.2015, p. 532-536.

Research output: Contribution to journalArticle

Samdani, Tushar ; Fancher, Tiffany T. ; Pieracci, Frederic M. ; Eachempati, Soumitra ; Rashidi, Laila ; Nash, Garrett M. / Is interval appendectomy indicated after non-operative management of acute appendicitis in patients with cancer? A retrospective review from a single institution. In: American Surgeon. 2015 ; Vol. 81, No. 5. pp. 532-536.
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abstract = "Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed nonoperatively (NOM) during index hospitalization (IHA) for acute appendicitis (AA). Clinical presentation, cancer treatment, and follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between August 1999 and August 2009. Seventy-two of 109 AA patients underwent appendectomy during IHA; 34 of these 109 wereNOMduring IHA.Median index length ofNOMpatients' stay was six days (0-55), median age was 59 (18-80) years. Indications for NOM were presence of abscess or phlegmon (14),mild symptoms (13), high surgical risk (3), end-stage cancer (3), and patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of intravenous 1 oral antibiotics 5 12 days [0-55]). There were six deaths (1 IHA, 5 NOM): four sepsis and two cancer progression. At a median of 19-month follow-up (range 1-103), four NOMpatients surviving IHA had recurrent AA (11.7{\%}) at two (n 5 2) and three months (n 5 2) after the first episode. Overall, six had IA (17.6{\%}) one to seven months post AA; 25 remained asymptomatic, without IA. In conclusion, among NOM patients at a cancer center at IHA for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up.",
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