A 55-year-old woman undergoes laparoscopic appendicectomy for presumed acute appendicitis. Histology reveals a well-differentiated appendiceal neuroendocrine tumor (NET) of 2.5 cm at the tip of the appendix with no local invasion or metastasis. What is the recommended management?

• A Appendicectomy alone is sufficient; size <2 cm is the threshold for right hemicolectomy
• B Octreotide therapy to prevent carcinoid syndrome
• C Re-laparoscopy with omentectomy to exclude peritoneal spread
• D Right hemicolectomy is recommended as the tumor is >2 cm ✓

Explanation

Appendiceal NETs (formerly carcinoid) <2 cm at the tip with no nodal or vascular invasion are cured by appendicectomy alone (cure rate >95%). Tumors >2 cm carry a significantly higher risk of nodal metastasis (30-40%) and right hemicolectomy with ileocolic lymphadenectomy is recommended. Tumors 1-2 cm with high-risk features (mesoappendiceal invasion >3 mm, lymphovascular invasion, goblet cell subtype) also warrant right hemicolectomy. This patient's 2.5 cm tumor warrants formal right hemicolectomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.