Histology of an appendicectomy specimen shows a well-differentiated neuroendocrine tumour of the appendix measuring 2.5 cm at the tip, with invasion into the mesoappendix and negative margins. What is the next step?

• A No further surgery, annual surveillance only
• B Completion right hemicolectomy plus octreotide therapy
• C Completion right hemicolectomy ✓
• D Local excision of the caecal pole

Explanation

Appendiceal neuroendocrine tumours larger than 2 cm, those with mesoappendix invasion, positive margins or goblet cell histology warrant completion right hemicolectomy because of significant risk of nodal metastasis. Tumours under 1 cm confined to the tip need only appendicectomy, and 1 to 2 cm lesions are managed individually based on risk features. Octreotide is used for functioning carcinoid syndrome, which is exceptional with appendiceal primaries.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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