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


COD: 2769_22_11_2017_EP Categorie: , ,

Nicola Tartaglia, Alessandra Di Lascia, Pasquale Cianci, Alberto Fersini, Francesca Sanguedolce*,
Roberta Iadarola, Sabino Capuzzolo, Vincenzo Neri, Antonio Ambrosi

Ann Ital Chir, Digital Edition 2017, 6
Epub, Nov. 2017

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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.