International Journal of Colorectal Disease

, Volume 34, Issue 1, pp 39–46 | Cite as

Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study

  • Elina LietzénEmail author
  • Juha M. Grönroos
  • Jukka-Pekka Mecklin
  • Ari Leppäniemi
  • Pia Nordström
  • Tero Rautio
  • Tuomo Rantanen
  • Juhani Sand
  • Hannu Paajanen
  • Anne Kaljonen
  • Paulina Salminen
Original Article



Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis.


This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals.


Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n = 250), and out of these, 41% (n = 102) were complicated and 59% (n = 148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p < 0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%.


Appendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.


Acute appendicitis Uncomplicated acute appendicitis Complicated acute appendicitis Non-operative treatment Appendectomy Appendiceal neoplasm 



This study was supported by a Turku University Hospital Government Research Grant (TYKS EVO Foundation), Paulo Foundation, and Constitution of The Gastroenterological Research Foundation.

Compliance with ethical standards

Conflict of interest

Dr. Salminen has received personal fees for lectures from Merck, Lilly, and Orion Pharma.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Elina Lietzén
    • 1
    • 2
    Email author
  • Juha M. Grönroos
    • 1
    • 2
  • Jukka-Pekka Mecklin
    • 3
    • 4
  • Ari Leppäniemi
    • 5
    • 6
  • Pia Nordström
    • 7
    • 8
  • Tero Rautio
    • 9
    • 10
  • Tuomo Rantanen
    • 11
    • 12
    • 13
  • Juhani Sand
    • 14
  • Hannu Paajanen
    • 15
  • Anne Kaljonen
    • 16
  • Paulina Salminen
    • 1
    • 2
  1. 1.Division of Digestive Surgery and Urology, Department of Digestive SurgeryTurku University HospitalTurkuFinland
  2. 2.University of TurkuTurkuFinland
  3. 3.Department of SurgeryJyväskylä Central Hospital and Sport and Health SciencesJyväskyläFinland
  4. 4.University of JyväskyläJyväskyläFinland
  5. 5.Department of Gastrointestinal SurgeryHelsinki University Central HospitalHelsinkiFinland
  6. 6.University of HelsinkiHelsinkiFinland
  7. 7.Division of Surgery, Gastroenterology and OncologyTampere University HospitalTampereFinland
  8. 8.University of TampereTampereFinland
  9. 9.Department of Surgery, Division of GastroenterologyOulu University HospitalOuluFinland
  10. 10.University of OuluOuluFinland
  11. 11.Department of SurgerySeinäjoki Central HospitalSeinäjokiFinland
  12. 12.Department of SurgeryKuopio University HospitalKuopioFinland
  13. 13.University of KuopioKuopioFinland
  14. 14.Health and Medical ServicesPäijät-Häme Joint Authority for Health and WellbeingLahtiFinland
  15. 15.Department of SurgeryMikkeli Central HospitalMikkeliFinland
  16. 16.The Department of BiostatisticsUniversity of TurkuTurkuFinland

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