A 22-year-old woman undergoes laparoscopic appendicectomy for acute appendicitis. Histology reports a well differentiated neuroendocrine (carcinoid) tumour, 1.2 cm in diameter, confined to the tip of the appendix with clear resection margins and no angioinvasion. What is the appropriate further management?
- A No further surgery, simple clinical follow-up ✓
- B Right hemicolectomy
- C Completion appendicectomy with mesoappendix excision
- D Octreotide therapy with annual octreotide scans
Correct answer: A. No further surgery, simple clinical follow-up
Explanation
Appendiceal neuroendocrine tumours under 2 cm, located away from the base, with clear margins and no adverse features, carry negligible risk of nodal metastasis and are adequately treated by appendicectomy alone. Right hemicolectomy with regional lymphadenectomy is indicated for tumours larger than 2 cm, invasion of the mesoappendix or base, positive margins, or goblet cell carcinoma with aggressive features. Octreotide therapy is for functioning metastatic disease only.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.