One stage surgery for synchronous liver metastasis from a neuroendocrine tumor of the colon

Abstract

INTRODUCTION: Neuroendocrine tumors (NETs) are a heterogeneous group of tumors. NET of colon represent less than 1% of colonic tumors. Synchronous liver metastases, present in 75-80%, are considered significant adverse prognostic indicators. Liver is the second commonest site for metastasis in patients with colorectal neuroendocrine tumors. Available treatment options include surgical resection, chemotherapy, biotherapy. Surgery is the gold standard for curative therapy and it is strictly related to the localization, the grade of tumor, and the stage of disease.

CASE REPORT: We present a 64-year-old man with clinical carcinoid syndrome. Colonoscopy revealed ileocecal valve vegetating mass with negative biopsy. CT scans of thorax and abdomen showed a voluminous lesion (10 cm of diameter) of right liver. CEA, CA 19.9 and aFP were all normal. Only urinary 5HIAASerum 5-hydroxyindoleactic acid and blood Chromogranin A were positive. Surgical strategy was to treat the primary tumor and the liver synchronous metastasis in one stage surgery.

DISCUSSION: Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. Although complete surgical resection remains the optimal therapy and aggressive surgical resection increases the 5-year survival of NETs with solitary liver metastasis to 100%. In this case, clinical status with doubt of carcinoid syndrome was essential for diagnosis and for subsequent surgical strategy with one stage surgery.

CONCLUSION: Resection of the primary tumor, liver metastases, and local mesenteric lymph node metastases is thought to strictly promote long-term survival and quality of life. Typically, a multidisciplinary approach is a cornerstone for decision making while dealing with this aggressive disease.