A 55-year-old man undergoes appendectomy for what appears to be acute appendicitis. Histopathology reveals a well-differentiated neuroendocrine tumor (carcinoid) of the appendix measuring 1.8 cm at the tip. What is the appropriate management?
- A Simple appendectomy is curative; no further treatment needed ✓
- B Right hemicolectomy should be performed for tumors >2 cm or with mesoappendix invasion
- C Adjuvant chemotherapy with somatostatin analogues
- D Re-operation with right hemicolectomy for all appendiceal carcinoids regardless of size
Correct answer: A. Simple appendectomy is curative; no further treatment needed
Explanation
Appendiceal neuroendocrine tumors (carcinoids) are the most common tumors of the appendix. The management is size-dependent: tumors ≤2 cm are almost never associated with metastases (risk <2%) and simple appendectomy is curative. Tumors >2 cm, those with mesoappendix invasion >3 mm, high-grade histology, or lymphovascular invasion carry higher metastatic risk and require right hemicolectomy for complete regional lymph node staging. A 1.8 cm well-differentiated tumor at the tip with no adverse features is adequately treated by appendectomy alone.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.