A 25-year-old male patient presents with clinical features suggestive of acute appendicitis. At laparotomy, a 2.5 cm growth is found at the base of the appendix. What is the most appropriate treatment plan?
A. Appendectomy
B. Right hemicolectomy
C. Appendectomy followed by right hemicolectomy at a later stage if the margins are positive
D. Limited ileo-caecal resection
The Correct Answer: C. Appendectomy followed by right hemicolectomy at a later stage if the margins are positive
Explanation:
– Initial Treatment (Appendectomy): The immediate step in managing this patient is to remove the appendix to address the acute appendicitis and to obtain the tumor for pathological examination.
– Assessment of Tumor Margins: After the initial appendectomy, the surgical team will examine the tumor margins. If cancer cells are found at the margins (positive margins), it indicates that the cancer may have spread beyond the appendix.
– Subsequent Treatment (Right Hemicolectomy): If the margins are positive, a right hemicolectomy, which involves removing the appendix, part of the ileum, and part of the cecum, will be performed at a later stage. This staged approach ensures a more thorough resection of any residual cancer while minimizing the extent of the initial surgery.
Comparison with Other Options:
– Appendectomy (A): While this is necessary for treating appendicitis, it may not be sufficient if the tumor is malignant and has positive margins.
– Right Hemicolectomy (B): This is more invasive and may not be necessary initially if the tumor can be managed with a less extensive surgery and later reassessment.
– Limited ileo-caecal resection (D): This approach might not be comprehensive enough for managing the potential spread of cancer, depending on the tumor’s characteristics.
Thus, option C represents a balanced approach, initially addressing the appendicitis and allowing for a comprehensive treatment plan based on the pathological findings.