maj
Shaima Ramadan- Institutionen för kliniska vetenskaper, Malmö
Title: Conservatively treated appendicitis and appendiceal tumours
Main Supervisor: Pamela Buchwald, MD, Associate Professor
Reviewers: Docent Catarina Tiselius Uppsala Universitet och docent Martin Salö Lunds Universitet
Abstract
Background
Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservative treatment vary, and the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. Furthermore, risk factors for recurrent appendicitis are not fully understood and previous studies from the adult population are inconsistent.
Aim
These projects aim to investigate the follow-up, recurrence and underlying appendiceal malignancy in patients with conservatively treated acute appendicitis, as well as, identify predictive factors for recurrent appendicitis.
Methods
Paper ⅰ: This retrospective cohort study included all patients ⩾ 18 years of age admitted at Skåne University Hospital (SUS), Sweden during 2012-2019 with conservatively treated acute appendicitis. Data from patients’ medical records in Melior regarding follow-up method, recurrence, appendectomy after initial conservative treatment and underlying malignancy were retrieved retrospectively.
Paper ⅰⅰ: This retrospective cohort study involved patients from the previous cohort in paper ⅰ, except for patients with underlying appendiceal malignancy. This study included clinical, laboratory and radiological parameters. Patient demographics, follow-up data, readmissions and appendectomy during follow-up were collected retrospectively from patients’ medical records in Melior. Cases with complex diagnostic images underwent secondary review by a radiologist. Uni -and multivariable logistic regression analysis were performed.
Results
Paper ⅰ: The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p=0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p=0.002).
Paper ⅰⅰ: In total, 379 patients with conservatively treated acute appendicitis were identified, of which 78 (20.6%) had recurrence. All patients were followed-up for a minimum of 41 months after first diagnosis of acute appendicitis unless appendectomy after successful NOM or death occurred during follow-up. Median time to recurrence was 6.5 (1-17.8) months. After multivariable logistic regression analysis, external appendix diameter >10 mm [OR 2.4 (CI 1.37-4.21), p=0.002] and intra-abdominal abscess [OR 2.05 (CI 1.18-3.56), p=0.011] on computed tomography were significant independent risk factors for recurrent appendicitis. Appendicolith was not associated with increased risk of recurrence.
Significance
The study results will be used to establish standardised guidelines regarding follow-up routines in conservatively treated acute appendicitis and help increase the chances of early detection of underlying appendiceal malignancy in this patient group.
Publications
Ramadan S, Buchwald P, Olsson Å. Risk of appendiceal malignancy in conservatively treated acute appendicitis. Scand J Surg. 2023:14574969231190293. https://doi.org/10.1177/14574969231190293
Other articles with co-authorship (not included in the present thesis)
Ofori JK, Karagiannopoulos A, Nagao M, Westholm E, Ramadan S, Wendt A, et al. Human Islet MicroRNA-200c Is Elevated in Type 2 Diabetes and Targets the Transcription Factor ETV5 to Reduce Insulin Secretion. Diabetes. 2022;71(2):275-84. https://doi.org/10.2337/db21-0077
Under review
Ramadan S, Olsson Å, Ekberg O, Buchwald P. Predictive factors for recurrent acute appendicitis after conservative treatment. Scand J G
Om evenemanget
Plats:
Sus Malmö, kirurgens Bibliotek, plan 3, Carl Bertil Laurells gata 9 Malmö
Kontakt:
shaima [dot] ramadan [at] med [dot] lu [dot] se