Do I require further surgery following my appendectomy?
Tumor size has been shown to be the best predictor of prognosis in patients with appendiceal carcinoid tumors; as such, the surgical management of appendiceal carcinoids depends largely on the size and location of the primary tumor. According to current guidelines, simple appendectomy is adequate for the treatment of small carcinoid tumors (< l cm). Indications for more extensive surgery than simple appendectomy have been shown to include tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. Given that approximately one-third of patients with tumors exceeding 2 cm in diameter will present or develop nodal and distant metastases, most experts advocate a right hemicolectomy as the appropriate treatment option. The management of tumors between 1 and 2 cm continues to be debated; however, a more aggressive treatment algorithm which includes right hemicolectomy is often employed, especially in younger patients. Additional prognostic factors (gender and depth of penetration) may be utilized in choosing between appendectomy and hemicolectomy in these patients.