Acute appendicitis in children with malignancies

Abstract Objective: To elucidate the clinical characteristics and treatment strategies for acute appendicitis in pediatric patients with cancer. Methods: A retrospective analysis was conducted on the clinical data of 31 pediatric patients with cancer who were diagnosed and treated for acute appendicitis at Beijing Children’s Hospital from March 2007 to October 2023. Results: The cohort comprised 31 patients with a mean age of 5.2 years (range 13 months to 15.3 years) and a male-to-female ratio of 4.2:1. The most prevalent underlying malignancy was acute lymphoblastic leukemia (22, 71%). The most common clinical manifestations were abdominal pain (23, 74%) and fever (27, 87%). Neutropenia was present in 81% of the patients. Nine patients underwent initial surgical treatment, while 22 received conservative management. The proportion of complicated appendicitis was significantly higher in the surgical group compared to the conservative treatment group (78% vs 23%, p = 0.012). However, the absolute neutrophil count was lower in the conservative treatment group compared to the surgical group (0.06 vs 0.35 × 10⁹/L, p = 0.006). The length of hospital stay was significantly shorter for patients who underwent laparoscopic surgery compared to the conservative treatment group (5 vs 9.0 days; p = 0.037). All patients were successfully treated for acute appendicitis with no mortality. Conclusion: Both surgical and conservative management are safe and effective treatment options for acute appendicitis in cancer children. Laparoscopic appendectomy may be a more advantageous approach, reducing hospital stay and potentially benefitting the management of the underlying malignancy.