Abstract
Aim-Background
To review the rare entity of gastroenteropancreatic neuroendocrine tumours (GEP NETs) and to present multimodality therapeutic approaches for liver metastases in this group of patients.
Case Report
We describe the case of a 57-year-old gentleman who presented at the Emergency Department with symptoms of complete large bowel obstruction due to a splenic flexure tumour. The patient underwent tumour extirpation by an extended left hemicolectomy with end colostomy (transverse colon), while multiple liver metastases (both lobes) were also palpated. His postoperative course was without any major complications and he was referred to a tertiary centre for further evaluation and treatment. Histology of the specimen was remarkable for low grade large bowel neuroendocrine carcinoma (G3 WHO 2010) pT3, N2b (TNM 2009).
Results
Small NETs can be managed with local resection but larger tumours require formal resection of the involved organ with its adjacent lymph nodes, staging of the disease and planning of further treatment. Octreoscan identifies the need for adjuvant therapy with somatostatin analogues. Hepatectomy, with or without preoperative contralateral of the affected lobe portal vein embolisation, is performed on patients with metastases isolated to one lobe, while orthotopic liver transplantation is reserved for patients meeting standard criteria.
Conclusions
The rarity of GEP-NETs along with the variations in their presenting symptoms is a challenging diagnosis for the attending physician. Surgical therapy remains the cornerstone of treatment, while numerous adjuncts (RFA, PRRT, SIRT, TACE) serve in the multimodality approach for patients with unresectable liver metastases.
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Bouras, P., Kostopoulos, G., Liori, A. et al. Gastroenteropancreatic neuroendocrine tumour presenting as complete large bowel obstruction: Literature review seizing upon a case. Hellenic J Surg 87, 325–331 (2015). https://doi.org/10.1007/s13126-015-0233-2
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DOI: https://doi.org/10.1007/s13126-015-0233-2