UKINETS2025 23rd National Conference of the UK and Ireland Neuroendocrine Tumour Society 2025 Poster Presentations (33 abstracts)
Case review – successful management of highly complex NET patients depends on the skills of MDTs
Chris Coldham 1 , Alex Boyd 1 , Rick Steeds 2 , Stephen Rooney 3 , Shanat Baig 3 , Ahmed Ashoub 3 , Samuel Denham 4 , Elizabeth Bradley 5 , Mohamed El-Sayed 6 , Simon Hughes 6 , Keith Roberts 7 & Tahir Shah 1
1Queen Elizabeth Hospital - Neuroendocrine Tumour Centre, Birmingham, United Kingdom; 2Queen Elizabeth Hospital - Cardiology, Birmingham, United Kingdom; 3Queen Elizabeth Hospital - Cardiac Surgery, Birmingham, United Kingdom; 4Queen Elizabeth Hospital - Anaesthetics, Birmingham, United Kingdom; 5Queen Elizabeth Hospital - Dietetics, Birmingham, United Kingdom; 6Queen Elizabeth Hospital - Radiology, Birmingham, United Kingdom; 7Queen Elizabeth Hospital - Liver Surgery, Birmingham, United Kingdom
Introduction/Background: Neuroendocrine Tumour patients can be highly complex and challenging to manage. A high burden of disease with significant symptoms can lead to NET related diseases requiring intense long-term management.
Aims: To examine the course of treatment of one patient presenting with NET and several disease related issues. These required serial interventions. This could educate the management of such patients in the future.
Material and Methods: The electronic case notes of this patient were examined, with the patient’s permission.
Results: The review showed that this individual had several NET related complications which presented a challenging treatment scenario. The patient was initially referred to us for PRRT. Imaging review suggested need for debulking liver surgery instead. During work up, a second primary lung NET was diagnosed, which was locally invasive and not operable. It also raised concerns for safe anaesthesia. Discussions between liver surgeons, liver anaesthetists and a thoracic surgeon agreed a plan for dealing any with bronchial NET related issues during anaesthesia for liver surgery. Work up for surgery however, demonstrated Carcinoid Heart Disease. Therefore, the patient required surgery for severe tricuspid regurgitation before liver surgery. A palliative approach was proposed. The patient’s NET physician however thought the patient’s issues were manageable through a stepwise approach, based on the patient’s good health, potential for recovery and a clear understanding of the skills of the surgical teams. Valve surgery took place first (March 2024), then liver resection (February 2025). Throughout, lung function, severe pancreatic enzyme insufficiency, frailty and nutritional depletion required a full multidisciplinary approach to allow the surgeries to proceed. The patient is now recovered from surgeries, under regular review and monitoring with nutritional improvement with normal 5HIAA. The lung carcinoid remains in situ with residual liver disease.
Conclusions: The case demonstrates the importance of the patient’s primary physician in delivering good outcomes. Their experience and skills in understanding the patient’s needs, ability to cope with treatments and most of all the long-term collaborations built with other expert teams providing solutions for particular problems. The clinical skills and decision-making process, together with the availability of widespread expertise were crucial.
Volume 114
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Endocrine Abstracts
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