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Comment & Response
June 5, 2019

Potential Benefit of Nonsurgical Management to Periappendicular Abscess—Reply

Author Affiliations
  • 1Division of Digestive Surgery, Turku University Hospital, Turku, Finland
  • 2Department of Surgery, Oulu University Hospital, Oulu, Finland
JAMA Surg. Published online June 5, 2019. doi:10.1001/jamasurg.2019.1685

In Reply We thank Li and Owyang for their feedback and interest in our trial.1 We fully agree that caution needs to be used when drawing conclusions from our trial data, and we have already stated this in the article by recognizing the inconclusiveness of the trial based on the ethically inevitable premature study termination resulting in an underpowered trial. However, the alarmingly high rate of appendiceal neoplasms in this small Peri–Appendicitis Acuta (PeriAPPAC) study population cannot be disregarded,1 and if it is validated by future studies, it would support routine interval appendectomy in this context. We have also acknowledged the need for further studies on this topic, but until further information is available from future studies, we agree on suggesting careful evaluation of interval appendectomy, at least in patients older than 40 years.

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