INCIDENTAL APPENDECTOMY DURING NEPHRECTOMY FOR WILMS-TUMOR

Incidental appendectomy is frequently performed during nephrectomy for Wilms' tumor. The rationale for this approach is that the onset of ap pendicitis during a period of neutropenia after chemotherapy may cause increased morbidity. Additionally, children receiving chemotherapy or radiation therapy, or both, may experience abdominal pain, producing a diagnostic dilemma if the appendix is still present. We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and fifty-five p atients (23.8 percent) had appendectomy at the time of nephrectomy. An inversion appendectomy was performed upon 188 patients, and the appen dix was excised in 267. Infectious complications and postoperative int estinal obstructions occurred with equal frequency in children who did or did not undergo appendectomy. The median follow-up period for the entire group of patients was 5.1 years. Only three of the 1,455 childr en (0.2 percent) who did not have an incidental appendectomy had appen dicitis at two, seven and ten months after nephrectomy. None of the th ree children experienced any perioperative morbidity after appendectom y. These data suggest that incidental removal of the appendix is not e ssential for children undergoing removal of a Wilms' tumor.