Neoadjuvant peptide receptor radionuclide therapy and modified multivisceral transplantation for an advanced small intestinal neuroendocrine neoplasm: An updated case report

Ashley K. Clift, Henk Giele, Srikanth Reddy, Rubens MacEdo, Adil Al-Nahhas, Harpreet S. Wasan, Gabriel E. Gondolesi, Rodrigo M. Vianna, Peter Friend, Anil Vaidya, Andrea Frilling

Research output: Contribution to journalReview article

Abstract

Small intestinal neuroendocrine neoplasms (SI-NEN) frequently metastasise to regional lymph nodes, and surgery is the mainstay of therapy for such patients. However, despite the possible use of advanced surgical techniques, the resection of both primary and locoregional diseases is not always attainable. Intestinal and multivisceral transplantation has been performed in a small number of patients with conventionally nonresectable, slow-growing tumours threatening the mesenteric root but has remained controversial. The use of donor skin in "sentinel flaps" in transplantation theoretically offers advantages in tailoring immunosuppression and monitoring for rejection. We represent (with extended follow-up) the first case of a patient with inoperable extensive mesenteric metastases from SI-NEN, who underwent neoadjuvant peptide receptor radionuclide therapy before a modified multivisceral transplant with a concomitant vascularised sentinel forearm flap. At 48 months after transplantation, our patient remained at full physical activity with no evidence of disease recurrence on either tumour biochemistry or radiological imaging.

Original languageEnglish (US)
Pages (from-to)247-253
Number of pages7
JournalInnovative Surgical Sciences
Volume2
Issue number4
DOIs
StatePublished - Dec 1 2017

Keywords

  • multivisceral
  • neoplasm
  • neuroendocrine
  • sentinel flap
  • transplantation

ASJC Scopus subject areas

  • Surgery

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