University of Oulu

Alajääski, J., Lietzén, E., Grönroos, J.M. et al. The association between appendicitis severity and patient age with appendiceal neoplasm histology—a population-based study. Int J Colorectal Dis 37, 1173–1180 (2022).

The association between appendicitis severity and patient age with appendiceal neoplasm histology : a population-based study

Saved in:
Author: Alajääski, Jenny1,2; Lietzén, Elina2,3; Grönroos, Juha M.2,3;
Organizations: 1Department of Surgery, Satasairaala Central Hospital, Pori, Finland
2University of Turku, Turku, Finland
3Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Turku, Finland
4Department of Surgery, Nova Hospital, Jyväskylä, Finland
5Sport and Health Sciences, Jyväskylä University, Jyväskylä, Finland
6Abdominal Center, Helsinki University Hospital, Helsinki, Finland
7University of Helsinki, Helsinki, Finland
8Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
9University of Tampere, Tampere, Finland
10Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland
11University of Oulu, Oulu, Finland
12Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
13Department of Surgery, Kuopio University Hospital, Kuopio, Finland
14University of Kuopio, Kuopio, Finland
15Department of Administration, Tampere University Hospital, Tampere, Finland
16Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
17Clinical Research Center, Turku University Hospital, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-09-15


Purpose: Recent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology.

Methods: This nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n= 840) and available medical reports (n= 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor.

Results: The severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98–32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69–9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95–88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67).

Conclusion: More malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.

see all

Series: International journal of colorectal disease
ISSN: 0179-1958
ISSN-E: 1432-1262
ISSN-L: 0179-1958
Volume: 37
Issue: 5
Pages: 1173 - 1180
DOI: 10.1007/s00384-022-04132-8
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: Open Access funding provided by University of Turku (UTU) including Turku University Central Hospital. This study was supported by the Finnish Government Research Grant (EVO Foundation) awarded to Satasairaala Central Hospital, Pori, Finland.
Copyright information: © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit