Emergency hepatic metastasectomy for symptomatic control of metastatic VIPoma

Vasoactive intestinal peptide-secreting tumours (VIPoma) are a rare subset of functioning pancreatic neuroendocrine tumours (pNET) which can lead to severe electrolyte derangement due to high volume secretory diarrhoea. Whilst surgery remains the mainstay in the management of non-metastatic disease, the role of debulking and surgical resection in metastatic disease is unclear, particularly with the proliferation of systemic therapy options. We outline a case of a male in his 80s presenting with severe metabolic derangements secondary to symptomatic metastatic VIPoma with hepatic metastases. He underwent a successful non-anatomical hepatic metastasectomy after initially failure of multiple lines of systemic medical therapy. The surgery was technically successful, and he recovered remarkably well in the post-operative period with almost immediate cessation of his symptoms.