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

Background

• Recent admission with acute cholecystitis

Issues

• 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

Discussion

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

Plan

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