Appendicitis Clinical Trial
— PeriAPPAC-TOfficial title:
The Prevalence of Appendiceal Tumours in Patients Presenting With a Periappendicular Abscess - A Nationwide Prospective Cohort Study
Complicated and uncomplicated appendicitis follow different epidemiological trends also suggesting different pathophysiology behind these two different forms of appendicitis. In 3-10% of patients complicated acute appendicitis is enclosed by formation of a circumscribed periappendicular abscess. The clinically established practice of antibiotic therapy and drainage, if necessary, has been shown safe and effective, allowing the acute inflammatory process to subside in more than 90% of cases without surgery. The need of subsequent interval appendectomy has been questioned with appendicitis recurrence risk varying between 5-26%. During trial enrollment in our randomized Peri-APPAC trial based on the interim analysis results with 17% appendiceal tumor rate in the study population, the trial was prematurely terminated based on ethical concerns. All the follow-up group patients were re-evaluated and surgery was offered and recommended to all follow-up group patients. After this assessment and additional appendectomies, two more tumors were diagnosed resulting in neoplasm rate of 20% in the whole study group all diagnosed in patients over 40 years and the neoplasm rate in patients over 40 years was 29%. Based on high appendiceal tumor rate in patients over 40 years, the appendiceal neoplasm rate needs to be further evaluated in prospective patient cohorts undergoing interval appendectomy as interval appendectomy is generally well tolerated and obliterates the risk of missing a possible tumor. In a recent systematic review of retrospective cohort studies with 13.244 acute appendicitis patients the overall appendiceal tumor rate was 1% after appendectomy, but in patients presenting with appendiceal inflammatory mass the neoplasm rate varied from 10% to 29%. This nationwide prospective multicenter cohort study is designed to assess the prevalence of appendiceal tumors associated with a periappendicular abscess. All consecutive patients presenting with a periappendicular abscess are recommended to undergo interval appendectomy after initial conservative treatment with antibiotic therapy and drainage, if necessary. All patients older than 35 years will undergo laparoscopic interval appendectomy at 2 to 3 months and this is also recommended for the patients between 18 and 35 years of age. Asymptomatic patients under 35 years not willing to undergo interval appendectomy, will undergo a follow-up MRI at 1 year after the initial non-operative treatment.
Status | Not yet recruiting |
Enrollment | 400 |
Est. completion date | December 31, 2035 |
Est. primary completion date | December 31, 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - periappendiceal abscess proven by CT, Mri or US Exclusion Criteria: - patient declines to participate, complicated appendicitis without periappendiceal abscess |
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
Turku University Hospital | Jyväskylä Central Hospital, Kuopio University Hospital, Lapland Central Hospital, Mikkeli Central Hospital, North Karelia Central Hospital, Oulu University Hospital, Päijänne Tavastia Central Hospital, Satakunta Central Hospital, Seinajoki Central Hospital, South Carelia Central Hospital, Tampere University Hospital, Vaasa Central Hospital, Vaasa, Finland |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | The Prevalence of Appendiceal Tumours in Periappendicular Abscess | The Prevalence of Appendiceal Tumours in Patients Presenting With a Periappendicular Abscess - A Nationwide Prospective Cohort Study | 2-3 months (interval appendectomy) | |
Secondary | Tympanic temperature | All patients | Day 0 (on primary admission) | |
Secondary | Imaging (primary diagnosis) finding | All patients | Day 0 (on primary admission) | |
Secondary | Duration of symptoms on admission | All patients | Day 0 (on primary admission) | |
Secondary | Laboratory value: CRP | CRP | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) | |
Secondary | Laboratory value: leuckocytes | leuk | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) | |
Secondary | Laboratory value: neutrophils | neutr | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) | |
Secondary | Laboratory value: hemoglobin | Hb | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) | |
Secondary | Laboratory value: kreatinine | Krea | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) | |
Secondary | Laboratory value: CEA | CEA | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital) and up to 1 year, if no interval appendectomy | |
Secondary | Laboratory value. Cg-A | Cg-A | Day 0 (on primary admission) up to 3-5 days (discharge from the hospital)and up to 1 year, if no interval appendectomy | |
Secondary | Primary nonoperative treatment | All patients, treatment details | Day 0 and up to one week | |
Secondary | Colonoscopy: endoscopic findings and histology | In both intervention groups | 2 weeks to 2 months prior to planned interval appendectomy | |
Secondary | Interval appendectomy specimen histology | Interval appendectomy patients | At 3 months | |
Secondary | Complications after interval appendectomy | Clavien-Dindo classification, interval appendectomy group | at the time of surgery | |
Secondary | Duration of hospital stay | All patients both at primary treatment, interval appendectomy and follow-up | up to 2 years | |
Secondary | Follow-up MRI findings | In case the patient does not under interval appendectomy | at 1 year | |
Secondary | follow-up CEA | Follow-up MRI patients | at 1 year | |
Secondary | follow-up CgA | Follow-up MRI patients | at 1 year | |
Secondary | Surgery after follow-up MRI | Follow-up with MRI patients | up to 10 years |
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