Endocrine Abstracts (2016) 46 P22 | DOI: 10.1530/endoabs.46.P22

Multivisceral transplantation and vascularised sentinel forearm flap for a metastatic small bowel neuroendocrine tumour: Update on follow-up

A Frilling1, H Giele2, G Vrakas3, S Reddy3, R Macedo3, A Al-Nahhas4, H Wasan1, AK Clift5, GE Gondolesi6, RM Vianna7, P Friend3 & A Vaidya3


1Department of Surgery and Cancer, Imperial College London, London, UK; 2Department of Plastic and Reconstructive Surgery, Oxford University NHS Trust, Oxford, UK; 3Oxford Transplant Centre, Oxford University NHS Trust, Oxford, UK; 4Department of Nuclear Medicine, Imperial College London, London, UK; 5School of Medicine, Imperial College London, London, UK; 6Instituto de Trasplante Multiorgánico, Fundación Favaloro, Buenos Aires, Argentina; 7Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.


Introduction: We previously reported the first documented case of a novel approach in a patient with extensive mesenteric metastases from a small bowel (SB) NET: this combined multivisceral transplantation (MVT) and a vascularised sentinel forearm flap (VSFF) from the same donor.

Aim(s): We re-present this case after 38-month follow-up post-MVT/VSFF.

Materials and methods: A 44-year old male patient was diagnosed with a well-differentiated, grade 1 (Ki67 <1%) neuroendocrine tumour. Initial gut hormones were raised: chromogranin A 395 pmol/l (normal <60), chromogranin B 349 pmol/l (normal <150) and 24 hr urinary 5-HIAA 643 μmol/l (normal <40). Pre-operative 68-Ga DOTATATE PET/CT showed uptake in an aorto-caval lymph node and bulky mesenteric disease, which was confirmed at laparotomy as stage IV disease encasing the mesenteric root. Numerous lymph nodes and multifocal primary tumour (7 sub-centimetre lesions) were also found at surgery.

Results: 4 cycles of neoadjuvant 177-Lu PRRT were followed by modified MVT (stomach, pancreas, spleen, small bowel, right hemi-colon), VSFF and resection of the aorto-caval lymph node. Disease stage was pT3 N1 M0 L1 V0 R0.

Conclusion: 38 months post-MVT/VSFF the patient is well and fully physically active with no evidence of disease recurrence on follow-up imaging or biochemistry. There was never any rejection in the visceral graft, with one mild, easily treated reaction in the VSFF. (Work published).

Keywords: neuroendocrine, transplantation, multivisceral, forearm flap