224 A Multimodal Management Strategy for Metastatic Neuroendocrine Tumour with Carcinoid Heart Disease: A Case Report

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Abstract Introduction Neuroendocrine tumours (NETs) of the small bowel are often indolent but typically present late with metastatic disease. Management becomes particularly complex in the presence of bilobar liver metastases and carcinoid heart disease. A multidisciplinary, multimodal approach is essential to achieve disease control and optimise patient outcomes in such challenging scenarios. Case Presentation A 58-year-old male was incidentally diagnosed with a DOTATATE-avid jejunal NET and extensive bilobar liver metastases during workup for elevated PSA. Further complexity was added by carcinoid heart disease requiring tricuspid valve replacement. Initial management involved bland embolisation of a dominant segment IVb/V liver lesion. This was followed by debulking surgery with non-anatomical resection of liver segments IVb, V, and VI, and cholecystectomy. Histology confirmed well-differentiated G1 NET with Ki-67 <2%. Residual left-lobe liver disease was treated with image-guided Irreversible Electroporation (IRE). Final surgical intervention included complete resection of the jejunal primary, mesenteric nodal clearance, and redo non-anatomical resection of liver segments VII and VIII. Discussion The case illustrates the value of a sequential, MDT-guided treatment strategy incorporating embolisation, surgical resection, and ablative therapies to manage extensive metastatic NET while addressing associated systemic disease. Conclusions The patient recovered well after surgery. Follow-up imaging shows no evidence of recurrence. Complete resection of the primary tumour has been achieved, and the case is currently pending further review at the specialist NET MDT.

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