Antibacterial therapy for acute appendicitis in pediatric patients with hematologic cancer undergoing chemotherapy

Purpose: A stratified treatment for acute appendicitis in children with blood cancer undergoing chemotherapy is yet to be established. This study aimed to compare treatment outcomes between antimicrobial therapy and appendectomy in pediatric patients with mild acute appendicitis. Methods Nine patients aged < 16 years who developed acute appendicitis during chemotherapy for blood cancers between January 2011 and October 2022 were included. Antimicrobial therapy was not indicated for cases with peritonitis. Clinical data were collected retrospectively, and the patients were divided into antimicrobial and surgical groups. Duration of treatment, duration of chemotherapy interruption, and complications were compared between the groups. Results There were no significant differences between the groups in mean age, primary disease ratio, white blood cell count at the onset of appendicitis, treatment duration, and chemotherapy interruption. The Pediatric Appendicitis Score was significantly lower in the antimicrobial group than in the surgical group (3.6 vs. 6.3, p = 0.004). There were no cases of antimicrobial resistance or complications. No recurrence of appendicitis was observed in the antimicrobial therapy group (mean follow-up: 27.8 months). Conclusion This study suggests that antimicrobial therapy is a treatment option for acute appendicitis without peritonitis in pediatric patients with hematological cancer.