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Increased Risk of Colon Cancer after Acute Appendicitis: A Nationwide, Population-Based Study
21 Pages Posted: 10 May 2023
More...Abstract
Background: Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis.
MethodsUsing the French Hospital Discharge Database (PMSI), we included all patients aged 18 to 59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients versus a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded.
Findings: A total of 230,512 patients with acute appendicitis were included. We used a propensity score to match each case with two controls to ensure the comparability of the groups, resulting in a control group of 461,024 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 2 per 10,000, p<0·0001). Multivariate analysis confirmed these results with an adjusted hazard ratio (aHR) of 3·93 (95% CI: 3·00-5·15). The association was even more marked for right-sided colon cancer (aHR=8·21; 95% CI: 4·24-15·89) compared to control patients. While the risk of developing colon cancer was significant for patients over 40 years, it was even greater in patients under 40 years, who had a 6-fold increase in risk.
Interpretation: In this population-based study, we found that acute appendicitis seems to be a warning sign for colon cancer (reverse causality) in both middle-aged and younger adults. This raises the issue of routine diagnostic work-up (i.e. colonoscopy) in all adults presenting with acute appendicitis.
Funding: Regional Council of Burgundy.
Declaration of Interest: No conflict of interest to declare.
Ethical Approval Statement: This study was conducted in accordance with the Declaration of Helsinki, and approved by the French National Commission for Data protection (No 1576793). Patient consent was not required as this national retrospective study was based on anonymous data. We are not allowed to transmit these data. PMSI data are available for researchers who meet the criteria for access to these French confidential data (this access is submitted to the approval of the National Committee for data protection) from the national agency for the management of hospitalization (ATIH - Agence technique de l'information sur l'hospitalisation).
Keywords: acute appendicitis, colon cancer, colonoscopy, population-based study
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