Appendiceal neuroendocrine tumors measuring 1–2 cm represent a clinically distinct group. When certain pathological features are present, management shifts toward a more extensive surgical approach.
This protocol applies when an appendiceal neuroendocrine tumor measures 1–2 cm in diameter and one or more of the following high-risk features are identified: tumor size > 15 mm, grading G2 (WHO 2010), and/or lympho-vascular invasion. These features are associated with a non-negligible risk of lymph node involvement and indicate that simple appendectomy alone may not provide definitive management.
When these high-risk features are confirmed, a surgical radicalization procedure is indicated. The full protocol details the specific operative approach and the extent of nodal management involved.
DOI: 10.1007/s11864-023-01093-0
In our opinion, patients presenting tumor size > 15 mm, grading G2 (according to WHO 2010), and/or lympho-vascular invasion should be referred for radicalization with RHC.
The clinical management of a T2 (ENETS) or T1b (UICC/AJCC) NET (i.e., tumors with diameters > 1 cm but < 2 cm) is more controversial because lymph node or distant metastases are uncommon but possible, so definitive cure can be achieved with a RHC.