Recently, PUMCH received a flag of praise and gratitude from a young patient. Two months before, Liver Surgery carried on her multiple metastases resection in pancreatic neuroendocrine tumor (PNET). The operation lasted eight hours, in which 30 specimen and nearly 50 metastases were removed.

The patient, 22 year old, saw her life changed by this strange disease. A year before she started to have agitations, sleep disorders, acnes and obvious increase in weight. After visiting many hospitals the diagnosis turned out to be pancreatic functional neuroendocrine tumor and ectopic ACTH syndrome. More unexpectedly, multiple metastases also appeared in liver, covering the whole liver as images showed.

The patient ended up in our hospital, who boasts a powerful multi-disciplinary team for neuroendocrine tumors. Experts from Endocrinology, General Surgery, Liver Surgery, Medical Oncology and others pool opinions and formulate individualized therapies. After ward rounds and MDT consultations, the diagnosis was PNET with liver multiple metastases (G2, IV). The solution was somatostatin analogues and tumor removal when hypercortisolemia is addressed.

After six months of medication, the patient’s blood and urine cortisol were nearly normal and images showed stable conditions. Another MDT consultation believed that, given the patient being a young woman, utmost efforts should be made to improve her conditions and prolong her survival, and the removal of primary tumor and metastases can both improve prognosis significantly. After discussion and communication with the patient and her family, it was decided that staged operations shall be made.

On January 2, 2019, the pancreatic team led by Associate Professor Han Xianlin from General Surgery carried out laparoscopic distal pancreatectomy, which was a success and recovery was good. On January 25, removal of multiple metastases was made. In the operation, multiple hard tumors were discovered all over the liver, most of them in the liver parenchyma near the surface, especially hepatic left lateral lobe, and the rest scattered elsewhere. Associate Professor Du Shunda and Attending Surgeon Wan Xueshuai carefully removed each metastasis, and destroyed those in the depth with radiofrequency ablation, trying to preserve the healthy parts as much as possible. The operation lasted eight hours, in which 30 specimen and nearly 50 metastases were removed. Under the support of anesthesiologists and nurses, the patient remained in stable conditions. Seven days after the operation she was discharged.

So far, consensus has been basically reached that for NET liver metastases (G1/G2), if conditions permit, complete removal of primary tumor and metastases, or even over 70% tumor reduction on liver, will improve prognosis. On treating NET, PUMCH has a powerful MDT system. Liver Surgery, as part of it, has rich experience in liver metastases and is helping more and more patients.

(Caption)

MRI shows liver multiple metastases.