A carcinoid tumour of the appendix is found incidentally in a 35-year-old woman undergoing appendicectomy for acute appendicitis. Histology shows a 1.2 cm well-differentiated NET at the tip with clear margins and no invasion of mesoappendix. What is the recommended management?
- A Appendicectomy alone is curative; no further surgery needed ✓
- B Right hemicolectomy is required for all carcinoid tumours
- C Chemotherapy with streptozocin
- D Surveillance with urinary 5-HIAA levels annually
Correct answer: A. Appendicectomy alone is curative; no further surgery needed
Explanation
Appendiceal carcinoids (NETs) <2 cm at the tip with no mesoappendix invasion, no lymphovascular invasion, and clear surgical margins are cured by appendicectomy alone with a >95% long-term survival. Right hemicolectomy is indicated for: tumours >2 cm, tumours involving the base of the appendix, mesoappendix invasion >3 mm, or lymphovascular invasion. Tumours 1–2 cm at the base require individual assessment. This 1.2 cm tip lesion with clear margins requires no further surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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