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

Autor: Jennifer Mull, Janika San Roman, Jason Pasley, Martin A. Schreiber, Alexis Cralley, Crystal Szczepanski, Morgan Collom, Maryam B. Tabrizi, Daniel Vazquez, Jocelyn To, Rondi B. Gelbard, Jeffrey Wild, Brandon Behrens, Ahmed E Elsharkawy, Richard D. Catalano, Elena Lita, Kaitlyn Proulx, Reginald Alouidor, D. Dante Yeh, Kailyn Kwong Hing, David C. Evans, Saskya Byerly, Victoria Sharp, Muhammad Zeeshan, David Turay, Marie Crandall, Matthew J. Bradley, Lewis E. Jacobson, Katelyn Young, Thomas Serena, Peter K. Kim, Stacie L. Allmond, Christopher M. Dodgion, Tala Kana’an, Ahmed I Eid, Jonathan M. Saxe, Savo Bou Zein Eddine, Daniel C. Cullinane, Jeffry Nahmias, Jennifer C. Roberts, Leon Naar, Steven D. Eyer, Lindsay O'Meara, Hang Zhang, Ali Fuat Kann Gok, Ryan A. Lawless, Erik J. Teicher, Bruce Long, David L. Morris, Carlos Rodriguez, Bellal Joseph, Nadine Barth, Haytham M.A. Kaafarani, Mohamed D. Ray-Zack, Georgia Vasileiou, Beatrice Sun, Victor Portillo, Laura Juarez
Rok vydání: 2020
Předmět:
Zdroj: Surgery. 168:701-706
ISSN: 0039-6060
DOI: 10.1016/j.surg.2020.05.044
Popis: 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 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.
Databáze: OpenAIRE
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