A 55-year-old woman is found to have a 2.5 cm carcinoid tumour (neuroendocrine tumour) at the tip of the appendix incidentally during laparoscopic cholecystectomy. The appendix is removed. What is the most appropriate next step?

• A No further intervention; appendicectomy is curative
• B Right hemicolectomy for potential nodal clearance ✓
• C Octreotide scintigraphy and liver biopsy
• D CT chest/abdomen/pelvis for staging only

Explanation

Appendiceal neuroendocrine tumours (NETs) ≤1 cm are cured by appendicectomy alone. For tumours 1-2 cm, most guidelines recommend appendicectomy alone unless adverse features (mesoappendix invasion >3 mm, lymphovascular invasion, high Ki-67, goblet cell carcinoid type) are present. For tumours >2 cm (including this 2.5 cm tumour), right hemicolectomy with lymph node dissection is recommended due to the significant risk of lymph node metastases (approximately 30%), even with apparent complete resection of the primary.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.