What are the NCCN recommendations for the treatment of appendix carcinoid tumors?

Updated: Feb 12, 2019
  • Author: Cameron K Tebbi, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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NCCN recommendations for appendix NETs are as follows [103] :

  • Tumors ≤2 cm confined to the appendix: Appendectomy
  • Tumors ≤2 cm with lymphovascular or mesoappendiceal invasion or atypical histologic features: More aggressive treatment can be considered
  • Incomplete resection or tumors >2 cm: Staging with abdominal/pelvic CT or MRI; if no distant disease, reexploration with a right hemicolectomy

The NANETS guidelines include the following recommendations [108] :

  • Excision for tumors ≤2 cm; consider right hemicolectomy with node dissection if high- risk features are present
  • Tumors >2 cm: Right hemicolectomy with node dissection

The 2016 ENETS revised guidelines recommendations include [109] :

  • Tumors ≤2 cm: simple appendicectomy unless incompletely resected
  • Right hemicolectomy with node dissection only in rare tumors measuring 1–2 cm but with positive or unclear margins or with deep mesoappendiceal invasion (ENETS T2), higher proliferation rate (G2) and/or vascular invasion
  • Tumors >2 cm: right hemicolectomy with node dissection

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