Oncologic Risk of Missed Appendiceal Tumors in Acute Appendicitis

What is the risk of missing aggressive appendiceal tumors when selecting patients with acute appendicitis for antibiotic-only management?In this cohort study of 2293 appendectomies, incidental tumors occurred in 37 patients (1.6%), with mostly small grade 1 (G1) neuroendocrine tumors (NETs). Aggressive tumors—all malignancies other than G1 NETs less than 2 cm and low-grade dysplastic polyps—were rare and consistently presented with the following high-risk preoperative features: age 60 years or older, symptoms for 14 days or longer, appendiceal diameter of 15 mm or greater on imaging, complicated appendicitis on imaging, or metastatic-appearing lesions.Rigorous preoperative selection can reliably exclude aggressive tumors, supporting the oncologic safety of antibiotic-only management.

Corresponding Author: Maxime K. Collard, MD, PhD, Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris VI, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (maxime.collard@aphp.fr).

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