Incidental Appendiceal Tumors During Appendectomy: A 19-year Retrospective Review at a Municipal Hospital

Introduction: Appendectomy is the most common emergency surgical procedure. While non-operative management (NOMA) has gained popularity, particularly during the COVID pandemic, there is concern that NOMA might miss appendiceal tumors, including malignant ones. We sought to investigate the incidence and distribution of appendiceal tumors among appendectomy patients to determine its impact on the decision to pursue NOMA. Methods: We conducted a retrospective review of 1694 appendectomies for acute appendicitis at our institution between January 2001 and December 2019, to identify pathology-confirmed neoplasms in appendiceal specimens. Results: We identified 24 tumors among 1694 cases, with an incidence of 1.43% and average age of 48.7 years. This included 9 Low Grade Appendiceal Mucinous Neoplasms (LAMNs), 6 neuroendocrine tumors (NETs), 6 Mucoceles without adenoma, and one each of adenocarcinoma, endometrioma, and neurofibroma. The incidence in our sample had a bimodal distribution, with peaks in the 2nd and 5th decades of life. Twenty cases were managed by appendectomy alone, with only 4 requiring colectomy. 4 of 24 cases with tumors (16.66%) also had appendicoliths while 343 of 1670 (20%) without neoplasms had appendicoliths. Conclusion: Appendiceal tumors were rare in our series, and most were cured with appendectomy alone. LAMNs and NETs were the most common tumors identified. All patients under 40 had relatively benign disease, and overall tumor incidence had a bimodal distribution, similar to other series. Incidence of appendicoliths was unaffected by the presence of tumor. We conclude that NOMA is a safe alternative to surgery in patients under 40.