Appendectomy versus observation for appendicitis in neutropenic children with cancer

Authors

Benjamin T. Many, Northwestern University
Timothy B. Lautz, Northwestern University
Sarah Dobrozsi, Children's Hospital of Wisconsin Wauwatosa
Katheryn Hope Wilkinson, Children's Hospital of Wisconsin Wauwatosa
Jenna Rossoff, Northwestern University
Annie Le-Nguyen, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Nawar Dakhallah, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Nelson Piche, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Whitney Weinschenk, Cincinnati Children's Hospital Medical Center
Jo Cooke-Barker, Cincinnati Children's Hospital Medical Center
Catherine Goodhue, Children's Hospital Los Angeles
Abigail Zamora, Children's Hospital Los Angeles
Eugene S. Kim, Children's Hospital Los Angeles
Lindsay J. Talbot, St. Jude Children's Research Hospital
Oswaldo Gomez Quevedo, St. Jude Children's Research Hospital
Andrew J. Murphy, St. Jude Children's Research Hospital
Sarah J. Commander, Duke University Medical Center
Elisabeth T. Tracy, Duke University Medical Center
Scott S. Short, University of Utah School of Medicine
Rebecka L. Meyers, University of Utah School of Medicine
Hannah N. Rinehardt, The Ohio State University College of Medicine
Jennifer H. Aldrink, The Ohio State University College of Medicine
Todd E. Heaton, Memorial Sloan-Kettering Cancer Center
Michael V. Ortiz, Memorial Sloan-Kettering Cancer Center
Reto Baertschiger, Hospital for Sick Children University of Toronto
Kaitlyn E. Wong, Hospital for Sick Children University of Toronto
Eveline Lapidus-Krol, Hospital for Sick Children University of Toronto
Andreana Butter, Western UniversityFollow
Jacob Davidson, Western University

Document Type

Article

Publication Date

2-1-2021

Journal

Pediatrics

Volume

147

Issue

2

URL with Digital Object Identifier

10.1542/peds.2020-027797

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.