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Long-term results of a selective surgical approach to management of Zollinger-Ellison syndrome in patients with MEN-1.
Am Surg. 2009 Aug; 75(8):730-3.AS

Abstract

The role of operation in patients with Multiple Endocrine Neoplasia Type 1 (MEN-1) and Zollinger-Ellison Syndrome (ZES) is controversial. Our institutional bias for this disease has, in general, been towards aggressive imaging and operative removal of localized gastrinomas. Few studies have reported long-term outcomes in patients with MEN-1 and ZES. A single institution retrospective review of all patients with MEN-1 and ZES from 1970 to present was performed. Twelve patients were identified (median age = 37 years at diagnosis). The median follow-up was 18 years from diagnosis of ZES. Common symptoms associated with gastrinoma in these patients were diarrhea (n = 6), abdominal pain (n = 4), and nausea/vomiting (n = 4). Most commonly identified sites of gastrinoma were: pancreas (n = 10), duodenum (n = 4), lymph nodes (n = 3), and liver (n = 1). Fifteen celiotomies were performed in total (median = 1; range 0-3). Operative procedures performed included: distal pancreatectomy (n = 4), acid reducing procedure (n = 4), enucleation of pancreatic gastrinoma (n = 3), duodenal resection (n = 3), pancreaticoduodenectomy (n = 1), and other (n = 7). One patient had a transient biochemical cure after operation lasting 3 years. Only one patient in this series had documented liver metastases of gastrinoma and no patients expired of metastatic gastrinoma. There was one postoperative patient death, secondary to respiratory arrest thought to be a result of aspiration or pulmonary embolus. Three patients died of nondisease related causes, and seven patients were alive at the time of last follow-up. Operations rarely result in biochemical cures in patients with MEN-1 and ZES. In our experience, resection of localized gastrinomas often did not require extended surgical resection and were associated with excellent long-term outcomes.

Authors+Show Affiliations

Division of Surgical Oncology, Department of Surgery, University of Florida, 1600 SW Archer Road, Gainesville, Florida 32609, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19725300

Citation

Mortellaro, Vincent E., et al. "Long-term Results of a Selective Surgical Approach to Management of Zollinger-Ellison Syndrome in Patients With MEN-1." The American Surgeon, vol. 75, no. 8, 2009, pp. 730-3.
Mortellaro VE, Hochwald SN, McGuigan JE, et al. Long-term results of a selective surgical approach to management of Zollinger-Ellison syndrome in patients with MEN-1. Am Surg. 2009;75(8):730-3.
Mortellaro, V. E., Hochwald, S. N., McGuigan, J. E., Copeland, E. M., Vogel, S. B., & Grobmyer, S. R. (2009). Long-term results of a selective surgical approach to management of Zollinger-Ellison syndrome in patients with MEN-1. The American Surgeon, 75(8), 730-3.
Mortellaro VE, et al. Long-term Results of a Selective Surgical Approach to Management of Zollinger-Ellison Syndrome in Patients With MEN-1. Am Surg. 2009;75(8):730-3. PubMed PMID: 19725300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term results of a selective surgical approach to management of Zollinger-Ellison syndrome in patients with MEN-1. AU - Mortellaro,Vincent E, AU - Hochwald,Steven N, AU - McGuigan,James E, AU - Copeland,Edward M, AU - Vogel,Stephen B, AU - Grobmyer,Stephen R, PY - 2009/9/4/entrez PY - 2009/9/4/pubmed PY - 2009/10/9/medline SP - 730 EP - 3 JF - The American surgeon JO - Am Surg VL - 75 IS - 8 N2 - The role of operation in patients with Multiple Endocrine Neoplasia Type 1 (MEN-1) and Zollinger-Ellison Syndrome (ZES) is controversial. Our institutional bias for this disease has, in general, been towards aggressive imaging and operative removal of localized gastrinomas. Few studies have reported long-term outcomes in patients with MEN-1 and ZES. A single institution retrospective review of all patients with MEN-1 and ZES from 1970 to present was performed. Twelve patients were identified (median age = 37 years at diagnosis). The median follow-up was 18 years from diagnosis of ZES. Common symptoms associated with gastrinoma in these patients were diarrhea (n = 6), abdominal pain (n = 4), and nausea/vomiting (n = 4). Most commonly identified sites of gastrinoma were: pancreas (n = 10), duodenum (n = 4), lymph nodes (n = 3), and liver (n = 1). Fifteen celiotomies were performed in total (median = 1; range 0-3). Operative procedures performed included: distal pancreatectomy (n = 4), acid reducing procedure (n = 4), enucleation of pancreatic gastrinoma (n = 3), duodenal resection (n = 3), pancreaticoduodenectomy (n = 1), and other (n = 7). One patient had a transient biochemical cure after operation lasting 3 years. Only one patient in this series had documented liver metastases of gastrinoma and no patients expired of metastatic gastrinoma. There was one postoperative patient death, secondary to respiratory arrest thought to be a result of aspiration or pulmonary embolus. Three patients died of nondisease related causes, and seven patients were alive at the time of last follow-up. Operations rarely result in biochemical cures in patients with MEN-1 and ZES. In our experience, resection of localized gastrinomas often did not require extended surgical resection and were associated with excellent long-term outcomes. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/19725300/Long_term_results_of_a_selective_surgical_approach_to_management_of_Zollinger_Ellison_syndrome_in_patients_with_MEN_1_ L2 - https://www.ingentaconnect.com/openurl?genre=article&issn=0003-1348&volume=75&issue=8&spage=730&aulast=Mortellaro DB - PRIME DP - Unbound Medicine ER -