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Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer. Pediatrics 2021 Feb;147(2)

Date

01/29/2021

Pubmed ID

33504609

DOI

10.1542/peds.2020-027797

Scopus ID

2-s2.0-85101298938 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration.

METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period.

RESULTS: Sixty-six children, with a median age of 11 years (range 1-17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P = .23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P = .05) and longer LOS (29 vs 12 days; P = .01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P < .01).

CONCLUSIONS: In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management.

Author List

Many BT, Lautz TB, Dobrozsi S, Wilkinson KH, Rossoff J, Le-Nguyen A, Dakhallah N, Piche N, Weinschenk W, Cooke-Barker J, Goodhue C, Zamora A, Kim ES, Talbot LJ, Quevedo OG, Murphy AJ, Commander SJ, Tracy ET, Short SS, Meyers RL, Rinehardt HN, Aldrink JH, Heaton TE, Ortiz MV, Baertschiger R, Wong KE, Lapidus-Krol E, Butter A, Davidson J, Stark R, Ramaraj A, Malek M, Mastropolo R, Morgan K, Murphy JT, Janek K, Le HD, Dasgupta R, Lal DR, PEDIATRIC SURGICAL ONCOLOGY RESEARCH COLLABORATIVE

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Appendectomy
Appendicitis
Chemotherapy-Induced Febrile Neutropenia
Child
Child, Preschool
Female
Humans
Infant
Male
Neoplasms
Retrospective Studies
Watchful Waiting