Lap chole and metastatic neuroendocrine tumour

64-year-old man for laparoscopic cholecystectomy following episode of acute cholecystitis.


  • Recent admission with acute cholecystitis


  • Metastatic Neuroendocrine Tumour (Grade 1)
  • Carcinoid syndrome
  • Origin I terminal ileum with Liver and nodal disease
  • Monthly Lantreotide – now stable disease
  • Experiences flushing and palpitations if consumes alcohol
  • ? Risk of carcinoid syndrome intraoperatively: Discussed with Oncologist. Uncertain regarding intraoperative risk. Indolent tumour therefore low risk assumed


Difficult to determine risk of carcinoid

  • Surgery needs to proceed, risk of further episodes of cholecystitis
  • No options for optimization
  • Consensus would proceed and have octreotide ready in room but not to give as prophylaxis


  • Proceed to surgery
  • Discussion with procedural anaesthetist
  • Ensure current therapy not interrupted by surgery
  • Octreotide infusion if develops symptoms