Acute appendicitis in children with malignancy

Objective: To investigate the treatment of acute appendicitis in children with malignant tumors. Methods: We retrospectively analyzed the clinical data of 31 children with malignant tumors who were diagnosed with acute appendicitis at the Beijing Children's Hospital from March 2007 to October 2023. Results: The mean age was 5.2 (3.1, 8.8) years, and the male-to-female ratio was 4.2:1. The most common malignant tumor was acute lymphoblastic leukemia (22, 71%). The main clinical manifestations of acute appendicitis were abdominal pain (23, 74%) and fever (27, 87%). Neutropenia was present in 25 (81%) patients. Surgical treatment was initially chosen for 9 patients, and conservative treatment was chosen for 22 patients. The proportion of complicated appendicitis in the surgical group was significantly higher than that in the conservative treatment group (78% vs 23%, p = 0.012). However, the absolute neutrophil count in the conservative treatment group was lower than that in the surgical group (0.06 109/L vs 0.35 109/L, p = 0.006). There was no difference in the formation of intra-abdominal abscess or adhesive intestinal obstruction caused by appendicitis between the surgical and conservative treatment groups, or between the severe neutropenia and non-severe neutropenia groups. The length of hospital stay (5.0 (2.5, 7.5) days) for patients who underwent laparoscopic surgery was significantly shorter than that for the conservative treatment group (9.0 (6.0, 12.5) days) (p = 0.037). All patients were cured of acute appendicitis, and there were no deaths. Conclusion: Both surgical treatment and conservative treatment with broad-spectrum antibiotics are safe and effective for acute appendicitis in children with malignant tumors. Laparoscopic appendectomy can shorten the length of hospital stay and may be more beneficial for the treatment of the underlying malignant disease in these patients.