A 26-year-old woman undergoes laparoscopic appendicectomy for right iliac fossa pain. Histology of the appendix reveals a well-differentiated neuroendocrine (carcinoid) tumour measuring 2.5 cm, confined to the wall with clear resection margins and no angioinvasion. What is the appropriate next step?
- A No further surgery, annual surveillance only
- B Octreotide therapy for six months
- C Completion right hemicolectomy ✓
- D Completion subtotal colectomy
Correct answer: C. Completion right hemicolectomy
Explanation
Appendiceal carcinoid tumours larger than 2 cm carry a significant risk of nodal metastasis and mandate completion right hemicolectomy even when margins are clear. Tumours under 1 cm treated by simple appendicectomy need nothing further, and 1 to 2 cm is a grey zone decided by base involvement and angioinvasion. Octreotide is for functioning metastatic disease, not adjuvant therapy here.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.