Single-center retrospective cohort study of oncological risk of missed appendiceal tumors in acute appendicitis

Antibitiotic-only management for uncomplicated acute appendicitis is increasingly adopted, raising concerns about missed appendiceal neoplasms. A retrospective cohort study at Hôpital Saint Antoine of the Sorbonne Université (Paris, France) assessed the prevalence, histologic spectrum, and predictors of incidental appendiceal tumors after appendectomy for acute appendicitis. In this cohort study of 2293 appendectomies (2013-2021), incidental tumors occurred in 37 patients (1.6%), with mostly small grade 1 neuroendocrine tumors (G1 NETs). Aggressive tumors – all malignancies other than G1 NETs less than 2 cm and low-grade dysplastic polyps – were rare and consistantly 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. The authors conclude that rigorous preoperative selection can reliably exclude aggressive tumors, supporting the oncologic safety of antibiotic-only management.