Small intestinal neuroendocrine neoplasms (SINEN)
frequently metastasise to regional lymph nodes, and
surgery is the mainstay of therapy for such patients. However,
despite the possible use of advanced surgical techniques,
the resection of both primary and locoregional
diseases is not always attainable. Intestinal and multivisceral
transplantation has been performed in a small
number of patients with conventionally nonresectable,
slow-growing tumours threatening the mesenteric root
but has remained controversial. The use of donor skin
in “sentinel flaps” in transplantation theoretically offers
advantages in tailoring immunosuppression and monitoring
for rejection. We represent (with extended followup)
the first case of a patient with inoperable extensive
mesenteric metastases from SI-NEN, who underwent neoadjuvant
peptide receptor radionuclide therapy before a
modified multivisceral transplant with a concomitant vascularised
sentinel forearm flap. At 48 months after transplantation,
our patient remained at full physical activity
with no evidence of disease recurrence on either tumour
biochemistry or radiological imaging.