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Increased incidence of bowel cancer after non-surgical treatment of appendicitis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Department of Medicine, Clinical Epidemiology Unit, Karolinska institutet.
Regional Cancer Centre, Uppsala University Hospital.
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2017 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, no 11, p. 2067-2075Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis.

PATIENTS AND METHODS: Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated.

RESULTS: Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1).

CONCLUSION: Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 43, no 11, p. 2067-2075
Keyword [en]
Appendiceal cancer, Appendicitis, Colorectal cancer, Non-surgical treatment
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-333277DOI: 10.1016/j.ejso.2017.08.016ISI: 000418107200012PubMedID: 28942236OAI: oai:DiVA.org:uu-333277DiVA, id: diva2:1155792
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-03-09Bibliographically approved
In thesis
1. Colorectal and appendiceal peritoneal metastases: From population studies to genetics
Open this publication in new window or tab >>Colorectal and appendiceal peritoneal metastases: From population studies to genetics
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Peritoneal dissemination of colorectal and appendiceal origin was previously considered the end-stage of malignant disease. Today, treatment with cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) has prolonged survival and cured some patients with peritoneal metastases (PM). Unfortunately, a majority of patients still have fatal outcomes. In this thesis, colorectal and appendiceal PM were studied from a wide population-based perspective down to the detailed perspectives of histopathology and genetics, with the aim of further contributing to prolonged survival.

In Paper I, the heterogeneous histopathology of PM was investigated and a substantial proportion of patients undergoing CRS and HIPEC were found to have surgical specimens lacking neoplastic epithelium. These patients had a favourable prognosis and the results illustrate the importance of thorough analysing and reporting of histopathology for understanding differences in survival outcomes and for improving patient selection. In Paper II, the role of inflammation in colorectal and appendiceal carcinogenesis was investigated at a population-based level. Patients with non-surgical treatment of appendicitis had an increased incidence of cancer (especially of appendiceal and right-sided colon cancer) compared to the general population. This should be taken into consideration in the discussion of optimal management of patients with appendicitis. In Paper III, risk factors for PM were studied with the aim of aiding in the detection of PM at earlier stages. Appendiceal and right-sided colon cancer, advanced tumour and node stages, mucinous histopathology and vascular invasion were identified as high risk features for developing PM, and should increase awareness of potential PM. In Paper IV, genome-wide chromosomal copy number alterations of PM were explored and associated with prognosis after CRS and HIPEC. Colorectal PM exhibited a wide range of alterations of which copy number gain on parts of chromosome 1p and 15q were significantly associated with poor prognosis and have the potential to be used as prognostic molecular markers in the future.

In conclusion, this thesis provides new insights into the field of colorectal and appendiceal cancer and PM to be used for improved patient selection, early detection and prevention, ultimately contributing to improved survival.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1441
Keyword
Peritoneal metastases; Peritoneal carcinomatosis; Pseudomyxoma peritonei; Colorectal cancer; Appendiceal cancer; Cytoreductive surgery; HIPEC; Appendicitis
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-340059 (URN)978-91-513-0266-9 (ISBN)
Public defence
2018-05-05, Grönwallsalen, Akademiska sjukhuset, ingång 70, bv, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-04-12 Created: 2018-03-09 Last updated: 2018-04-12

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Enblad, MalinBirgisson, HGraf, Wilhelm

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