Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
J Laparoendosc Adv Surg Tech A. 2020 Dec;30(12):1344-1349. doi: 10.1089/lap.2019.0737. Epub 2020 Jul 15.
The rates of incidental appendiceal neoplasms after appendectomy performed for acute appendicitis is <2%. To date, no large studies have investigated the preoperative risk factors or imaging findings associated with incidental appendiceal tumors that present as appendicitis. Our study aims to identify preoperative factors that are associated with an increased risk of appendiceal tumors in patients who present with signs and symptoms of acute appendicitis. Using the targeted appendectomy American College of Surgeons National Surgical Quality Improvement Program database, we identified patients who underwent nonelective appendectomy for acute appendicitis in 2016. Patients with final pathology consistent with a tumor were compared with those with only appendicitis. A nonmatched case/control method was used to pull a random sample from the appendicitis cohort using a 1:4 ratio (tumor: acute appendicitis) to obtain adequate power for comparison. Preoperative patient variables and imaging findings were investigated using stepwise logistic regression to identify variables associated with appendiceal tumor. Following multivariate analysis, preoperative imaging read of "indeterminate" and "not consistent with appendicitis," female gender, increased age, and lower preoperative white blood cell (WBC) count were significant predictors of tumor causing symptoms of appendicitis. The odds of having tumor pathology were significantly increased in patients with preoperative imaging of "indeterminate" and "not consistent with appendicitis." The odds of having tumor pathology were 82% higher for females than for males, increased by 2% for every 1-year increase in age, and increased by 3% for every one-unit decrease in WBC count. While incidental appendiceal tumors can present as acute appendicitis, 3 patient variables and one imaging finding were identified that may increase suspicion for appendiceal tumors. Consideration should be given to patients with these associated risk factors for additional preoperative consultation in addition to the potential for intraoperative pathology consultation.
阑尾切除术后偶然发现的阑尾肿瘤发生率<2%。迄今为止，尚无大型研究探讨与表现为阑尾炎的偶然阑尾肿瘤相关的术前危险因素或影像学表现。我们的研究旨在确定与表现为急性阑尾炎的患者中阑尾肿瘤风险增加相关的术前因素。
使用有针对性的阑尾切除术美国外科医师学会国家手术质量改进计划数据库，我们确定了 2016 年因急性阑尾炎接受非选择性阑尾切除术的患者。将最终病理与肿瘤一致的患者与仅患有阑尾炎的患者进行比较。使用非匹配病例对照方法，以 1:4 的比例（肿瘤：急性阑尾炎）从阑尾炎队列中随机抽取样本，以获得足够的比较能力。使用逐步逻辑回归调查术前患者变量和影像学发现，以确定与阑尾肿瘤相关的变量。
多元分析后，术前影像学检查结果为“不确定”和“不符合阑尾炎”、女性、年龄增加和术前白细胞计数（WBC）降低是阑尾肿瘤导致阑尾炎症状的显著预测因素。术前影像学检查为“不确定”和“不符合阑尾炎”的患者发生肿瘤病理的可能性显著增加。与男性相比，女性发生肿瘤病理的可能性高 82%，年龄每增加 1 岁，发生肿瘤病理的可能性增加 2%，WBC 计数每降低 1 个单位，发生肿瘤病理的可能性增加 3%。
虽然偶然的阑尾肿瘤可能表现为急性阑尾炎，但已确定 3 个患者变量和 1 个影像学表现可能会增加对阑尾肿瘤的怀疑。除了术中病理咨询的可能性外，还应考虑具有这些相关危险因素的患者进行额外的术前咨询。
