Thirty years' experience with gastrinoma (original) (raw)

Surgical treatment of gastrinomas: a single-centre experience

HPB, 2012

Background: Gastrinomas are rare neuroendocrine tumours, and responsible for Zollinger-Ellison syndrome (ZES). Surgery is the only treatment that can cure gastrinomas. The success of surgical treatment of gastrinomas in a single centre was evaluated.

Gastrinoma: State of the Art

Cancer Control, 1997

Management of the primary gastrinoma has replaced the focus on control of gastric ulceration. Background: The Zollinger-Ellison syndrome, implicating a gastrinoma, was first recognized as a disease entity in 1955. At that time, total gastrectomy was the most common treatment approach. Advances in several aspects of the disease have occurred since that time. Methods: The authors reviewed the changes that have developed since 1955 in the diagnosis, imaging studies, operative and nonoperative management, and follow-up of patients with this disease. Results: The presence of a gastrinoma can be confirmed by a secretin stimulation test. A variable number of patients have hyperparathyroidism as part of the multiple endocrine neoplasm syndrome type 1 (MEN 1). Localization of the primary gastrinoma has been assisted by selective angiography, endoscopic ultrasonography, and the octreotide scan. H2-blockers or omeprazole, sometimes at high doses, usually controls acid secretion. Surgical removal of the primary gastrinoma is performed when feasible, and parathyroidectomy is indicated in those patients with hyperparathyroidism in the MEN 1 syndrome. Follow-up is facilitated by measurement of fasting serum gastrin levels. Conclusions: Several innovations have improved our capability to diagnose and effectively manage patients with gastrinoma.

50-Year Appraisal of Gastrinoma: Recommendations for Staging and Treatment

Journal of the American College of Surgeons, 2006

BACKGROUND: Gastrinoma is a rare neuroendocrine tumor associated with ulcerogenic syndrome. The purpose of this study was to provide information on current controversies related to treatment, including staging, patient selection, and outcomes for surgical resection. STUDY DESIGN: A retrospective review of 106 patients with gastrinoma. Patients were classified as sporadic gastrinoma (SG) or MEN. End points of analysis included disease-free and disease-specific survival. Kaplan-Meier survival analysis was performed and significance (p Ͻ 0.05) was determined by Mantel-Haenszel log-rank test.

Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients

World Journal of Gastroenterology, 2011

Author contributions: Imamura M (chief surgeon), Komoto I, Ota S, Doi R, Awane M and Inoue N performed surgery for gastrinomas and duodenopancreatic neuroendocrine tumors in MEN 1 patients; Hiratsuka T performed pathological research on the resected pancreatoduodenal neuroendocrine tumors; Kosugi S performed genetic analysis of the patients with MEN 1.

Surgery Increases Survival in Patients With Gastrinoma

Annals of Surgery, 2006

To determine whether the routine use of surgical exploration for gastrinoma resection/cure in 160 patients with Zollinger-Ellison syndrome (ZES) altered survival compared with 35 ZES patients who did not undergo surgery. Summary Background Data: The role of routine surgical exploration for resection/cure in patients with ZES has been controversial since the original description of this disease in 1955. This controversy continues today, not only because medical therapy for acid hypersecretion is so effective, but also in large part because no studies have shown an effect of tumor resection on survival. Methods: Long-term follow-up of 160 ZES patients who underwent routine surgery for gastrinoma/resection/cure was compared with 35 patients who had similar disease but did not undergo surgery for a variety of reasons. All patients had preoperative CT, MRI, ultrasound; if unclear, angiography and somatostatin receptor scintigraphy since 1994 to determine resectability. At surgery, all had the same standard ZES operation. All patients were evaluated yearly with imaging studies and disease activity studies. Results: The 35 nonsurgical patients did not differ from the 160 operated in clinical, laboratory, or tumor imaging results. The 2 groups did not differ in follow-up time since initial evaluation (range, 11.8-12 years). At surgery, 94% had a tumor removed, 51% were cured immediately, and 41% at last follow-up. Significantly more unoperated patients developed liver metastases (29% vs. 5%, P ϭ 0.0002), died of any cause (54 vs. 21%, P ϭ 0.0002), or died a disease-related death (23 vs. 1%, P Ͻ 0.00001). Survival plots showed operated patients had a better disease-related survival (P ϭ 0.0012); however, there was no difference in non-disease-related survival. Fifteen-year disease-related survival was 98% for operated and 74% for unoperated (P ϭ 0.0002). Conclusions: These results demonstrate that routine surgical exploration increases survival in patients with ZES by increasing diseaserelated survival and decreasing the development of advanced disease. Routine surgical exploration should be performed in ZES patients.

Management of sporadic and multiple endocrine neoplasia type 1 gastrinomas

British Journal of Surgery, 2007

Background: Gastrinomas are functional endocrine duodenopancreatic tumours and are responsible for Zollinger-Ellison syndrome (ZES). Clinical presentation, localization techniques and operative management were reviewed. Methods: An electronic search of the Medline database was undertaken for articles published in English between January 1987 and May 2007. This timeframe was chosen because of the fundamental changes in operative strategy, antisecretory therapy and localization techniques during this period. Results and conclusion: Most gastrinomas are located in the 'gastrinoma triangle', comprising the head of the pancreas, and the first and second parts of the duodenum. Some 20 per cent of gastrinomas occur in association with multiple endocrine neoplasia type 1 (MEN1) and 50-60 per cent of tumours are malignant at the time of diagnosis. Biochemical evidence justifies operation of which duodenotomy is an essential part. Only complete tumour resection allows 5-and 10-year survival rates of 90 per cent. Pylorus-preserving pancreaticoduodenectomy may be the procedure of choice for MEN1-ZES.

Gastrinomas: Medical or Surgical Treatment

Endocrinology and metabolism clinics of North America, 2018

This article reviews the role of surgical and medical management in patients with Zollinger-Ellison syndrome (ZES) due to a gastrin-secreting neuroendocrine tumor (gastrinoma). It concentrates on the status at present but also briefly reviews the changes over time in treatment approaches. Generally, surgical and medical therapy are complementary today; however, in some cases, such as patients with ZES and multiple endocrine neoplasia type 1, the treatment approach remains controversial.