UKINETS2016 Poster Presentations (1) (35 abstracts)
Multivisceral transplantation and vascularised sentinel forearm flap for a metastatic small bowel neuroendocrine tumour: Update on follow-up
A Frilling 1 , H Giele 2 , G Vrakas 3 , S Reddy 3 , R Macedo 3 , A Al-Nahhas 4 , H Wasan 1 , AK Clift 5 , GE Gondolesi 6 , RM Vianna 7 , P Friend 3 & A Vaidya 3
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
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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