Antibiotic-only management for acute appendicitis is generally safe, but requires vigilance for missed tumors.

• In a study of 2,293 appendectomies, only 1.6% had malignant lesions, most being low-grade neuroendocrine tumors under 2 cm.
• Aggressive tumors were mostly found in older patients with prolonged symptoms and larger appendiceal diameters.

Surgical criteria can help identify low-risk candidates for antibiotic management.

• 74% of patients overall, and 85% of those with uncomplicated cases, met criteria for antibiotic-only treatment without risking undetected malignancy.