Histology of an appendicectomy specimen reveals a 7 mm carcinoid tumour at the tip of the appendix, with clear resection margins, no angiolymphatic invasion and no involvement of the mesoappendix. The patient is 30 years old and well. What is the correct management?

• A Completion right hemicolectomy
• B Somatostatin receptor scintigraphy followed by en-bloc ileocaecal resection
• C Completion hemicolectomy combined with chemotherapy
• D No further surgery, simple appendectomy was curative ✓

Explanation

Appendiceal neuroendocrine tumours smaller than 1 cm located at the tip, without lymphovascular invasion, base involvement or mesoappendix extension, are cured by simple appendectomy alone and need no further resection or imaging. Right hemicolectomy is indicated only when the tumour exceeds 2 cm, involves the base of the appendix, invades the mesoappendix, or shows lymphovascular invasion. This 7 mm tip lesion satisfies none of those criteria, killing the completion hemicolectomy distractor.

Reference: Sabiston Textbook of Surgery, 21st ed.

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