During routine appendicectomy in a 30-year-old man, histology shows a 2 cm well differentiated neuroendocrine tumour (carcinoid) at the base of the appendix, with clear margins but invasion beyond the muscularis propria. No nodes were sampled. What is the correct management?
- A No further treatment, follow-up with urinary 5-HIAA
- B Completion subtotal colectomy with ileorectal anastomosis
- C Completion right hemicolectomy ✓
- D Somatostatin analogue therapy for one year
Correct answer: C. Completion right hemicolectomy
Explanation
Appendiceal neuroendocrine tumours smaller than 1 cm confined to the organ need only appendicectomy. Tumours larger than 2 cm, those invading the base of the appendix, or those with angioinvasion or beyond muscularis invasion warrant completion right hemicolectomy with regional lymphadenectomy, because nodal metastasis risk rises sharply above these thresholds. Subtotal colectomy is excessive for a localised appendiceal lesion, and somatostatin analogues are used only for metastatic or functioning disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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