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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer

Benjamin T. Many, Timothy B. Lautz, Sarah Dobrozsi, Katheryn Hope Wilkinson, Jenna Rossoff, Annie Le-Nguyen, Nawar Dakhallah, Nelson Piche, Whitney Weinschenk, Jo Cooke-Barker, Catherine Goodhue, Abigail Zamora, Eugene S. Kim, Lindsay J. Talbot, Oswaldo Gomez Quevedo, Andrew J. Murphy, Sarah J. Commander, Elisabeth T Tracy, Scott S. Short, Rebecka L. Meyers, Hannah N. Rinehardt, Jennifer H. Aldrink, Todd E. Heaton, Michael V. Ortiz, Reto Baertschiger, Kaitlyn E. Wong, Eveline Lapidus-Krol, Andreana Butter, Jacob Davidson, Rebecca Stark, Akila Ramaraj, Marcus Malek, Rosemarie Mastropolo, Katrina Morgan, Joseph T. Murphy, Kevin Janek, Hau D. Le, Roshni Dasgupta, Dave R. Lal and ON BEHALF OF THE PEDIATRIC SURGICAL ONCOLOGY RESEARCH COLLABORATIVE
Pediatrics February 2021, 147 (2) e2020027797; DOI: https://doi.org/10.1542/peds.2020-027797
Benjamin T. Many
aAnn and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois;
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Timothy B. Lautz
aAnn and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois;
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Sarah Dobrozsi
bDivision of Pediatric Surgery, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin;
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Katheryn Hope Wilkinson
bDivision of Pediatric Surgery, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin;
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Jenna Rossoff
aAnn and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois;
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Annie Le-Nguyen
cCentre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada;
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Nawar Dakhallah
cCentre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada;
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Nelson Piche
cCentre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada;
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Whitney Weinschenk
dCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Jo Cooke-Barker
dCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Catherine Goodhue
eChildren’s Hospital of Los Angeles, Los Angeles, California;
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Abigail Zamora
eChildren’s Hospital of Los Angeles, Los Angeles, California;
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Eugene S. Kim
eChildren’s Hospital of Los Angeles, Los Angeles, California;
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Lindsay J. Talbot
fSt Jude Children’s Research Hospital, Memphis, Tennessee;
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Oswaldo Gomez Quevedo
fSt Jude Children’s Research Hospital, Memphis, Tennessee;
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Andrew J. Murphy
fSt Jude Children’s Research Hospital, Memphis, Tennessee;
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Sarah J. Commander
gDivision of Pediatric General Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina;
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Elisabeth T Tracy
gDivision of Pediatric General Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina;
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Scott S. Short
hDepartment of Surgery, School of Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah;
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Rebecka L. Meyers
hDepartment of Surgery, School of Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah;
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Hannah N. Rinehardt
iDepartment of Surgery, College of Medicine, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio;
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Jennifer H. Aldrink
iDepartment of Surgery, College of Medicine, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio;
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Todd E. Heaton
jMemorial Sloan Kettering Cancer Center, New York, New York;
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Michael V. Ortiz
jMemorial Sloan Kettering Cancer Center, New York, New York;
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Reto Baertschiger
kThe Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada;
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Kaitlyn E. Wong
kThe Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada;
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Eveline Lapidus-Krol
kThe Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada;
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Andreana Butter
lChildren’s Hospital, London Health Sciences Centre and Western University, London, Ontario, Canada;
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Jacob Davidson
lChildren’s Hospital, London Health Sciences Centre and Western University, London, Ontario, Canada;
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Rebecca Stark
mDivision of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington;
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Akila Ramaraj
mDivision of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington;
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Marcus Malek
nUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
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Rosemarie Mastropolo
nUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
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Katrina Morgan
nUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
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Joseph T. Murphy
oThe University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas; and
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Kevin Janek
pAmerican Family Children’s Hospital and University of Wisconsin-Madison, Madison, Wisconsin
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Hau D. Le
pAmerican Family Children’s Hospital and University of Wisconsin-Madison, Madison, Wisconsin
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Roshni Dasgupta
dCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Dave R. Lal
bDivision of Pediatric Surgery, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin;
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BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration.

METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period.

RESULTS: Sixty-six children, with a median age of 11 years (range 1–17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P = .23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P = .05) and longer LOS (29 vs 12 days; P = .01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P < .01).

CONCLUSIONS: In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management.

  • Accepted November 18, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer
Benjamin T. Many, Timothy B. Lautz, Sarah Dobrozsi, Katheryn Hope Wilkinson, Jenna Rossoff, Annie Le-Nguyen, Nawar Dakhallah, Nelson Piche, Whitney Weinschenk, Jo Cooke-Barker, Catherine Goodhue, Abigail Zamora, Eugene S. Kim, Lindsay J. Talbot, Oswaldo Gomez Quevedo, Andrew J. Murphy, Sarah J. Commander, Elisabeth T Tracy, Scott S. Short, Rebecka L. Meyers, Hannah N. Rinehardt, Jennifer H. Aldrink, Todd E. Heaton, Michael V. Ortiz, Reto Baertschiger, Kaitlyn E. Wong, Eveline Lapidus-Krol, Andreana Butter, Jacob Davidson, Rebecca Stark, Akila Ramaraj, Marcus Malek, Rosemarie Mastropolo, Katrina Morgan, Joseph T. Murphy, Kevin Janek, Hau D. Le, Roshni Dasgupta, Dave R. Lal, ON BEHALF OF THE PEDIATRIC SURGICAL ONCOLOGY RESEARCH COLLABORATIVE
Pediatrics Feb 2021, 147 (2) e2020027797; DOI: 10.1542/peds.2020-027797

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Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer
Benjamin T. Many, Timothy B. Lautz, Sarah Dobrozsi, Katheryn Hope Wilkinson, Jenna Rossoff, Annie Le-Nguyen, Nawar Dakhallah, Nelson Piche, Whitney Weinschenk, Jo Cooke-Barker, Catherine Goodhue, Abigail Zamora, Eugene S. Kim, Lindsay J. Talbot, Oswaldo Gomez Quevedo, Andrew J. Murphy, Sarah J. Commander, Elisabeth T Tracy, Scott S. Short, Rebecka L. Meyers, Hannah N. Rinehardt, Jennifer H. Aldrink, Todd E. Heaton, Michael V. Ortiz, Reto Baertschiger, Kaitlyn E. Wong, Eveline Lapidus-Krol, Andreana Butter, Jacob Davidson, Rebecca Stark, Akila Ramaraj, Marcus Malek, Rosemarie Mastropolo, Katrina Morgan, Joseph T. Murphy, Kevin Janek, Hau D. Le, Roshni Dasgupta, Dave R. Lal, ON BEHALF OF THE PEDIATRIC SURGICAL ONCOLOGY RESEARCH COLLABORATIVE
Pediatrics Feb 2021, 147 (2) e2020027797; DOI: 10.1542/peds.2020-027797
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