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Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients.
World J Gastroenterol. 2011 Mar 14; 17(10):1343-53.WJ

Abstract

AIM

To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1.

METHODS

Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 (MEN 1) and Zollinger-Ellison syndrome (ZES) underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors (NETs) between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test (SASI test) with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy (SRS) and other imaging methods such as computed tomography (CT) or magnetic resonance imaging (MRI). The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery: pancreaticoduodenectomy (PD) was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes (LR), and recently pancreas-preserving total duodenectomy (PPTD) has been performed for multiple duodenal gastrinomas.

RESULTS

Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients (87.5%); that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR (although in 2 patients (33.3%) second LR was performed for recurrence of duodenal gastrinoma), and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the resected specimens revealed co-existence of pancreatic gastrinoma with duodenal gastrinoma in 2 of 16 patients (13%), and G cell hyperplasia and/or microgastrinoma in the duodenal Brunner's gland was revealed in all of 7 duodenal specimens after PPTD.

CONCLUSION

Aggressive resection surgery based on accurate localization with the SASI test was useful for biochemical cure of gastrinoma in patients with MEN 1.

Authors+Show Affiliations

Department of Surgery, Kansa Electric Power Company Hospital, Osaka, Japan. imamura.masayuki@c4.kepco.co.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21455335

Citation

Imamura, Masayuki, et al. "Biochemically Curative Surgery for Gastrinoma in Multiple Endocrine Neoplasia Type 1 Patients." World Journal of Gastroenterology, vol. 17, no. 10, 2011, pp. 1343-53.
Imamura M, Komoto I, Ota S, et al. Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients. World J Gastroenterol. 2011;17(10):1343-53.
Imamura, M., Komoto, I., Ota, S., Hiratsuka, T., Kosugi, S., Doi, R., Awane, M., & Inoue, N. (2011). Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients. World Journal of Gastroenterology, 17(10), 1343-53. https://doi.org/10.3748/wjg.v17.i10.1343
Imamura M, et al. Biochemically Curative Surgery for Gastrinoma in Multiple Endocrine Neoplasia Type 1 Patients. World J Gastroenterol. 2011 Mar 14;17(10):1343-53. PubMed PMID: 21455335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients. AU - Imamura,Masayuki, AU - Komoto,Izumi, AU - Ota,Shuichi, AU - Hiratsuka,Takuya, AU - Kosugi,Shinji, AU - Doi,Ryuichiro, AU - Awane,Masaaki, AU - Inoue,Naoya, PY - 2010/08/17/received PY - 2010/11/03/revised PY - 2010/11/10/accepted PY - 2011/4/2/entrez PY - 2011/4/2/pubmed PY - 2011/8/10/medline KW - Duodenopancreatic neuroendocrine tumors KW - Gastrinoma KW - Multiple endocrine neoplasia type 1 KW - Pancreas-preserving total duodenectomy KW - Pancreaticoduodenectomy KW - Selective arterial secretagogue injection test KW - Somatostatin receptor scintigraphy SP - 1343 EP - 53 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 17 IS - 10 N2 - AIM: To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS: Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 (MEN 1) and Zollinger-Ellison syndrome (ZES) underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors (NETs) between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test (SASI test) with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy (SRS) and other imaging methods such as computed tomography (CT) or magnetic resonance imaging (MRI). The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery: pancreaticoduodenectomy (PD) was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes (LR), and recently pancreas-preserving total duodenectomy (PPTD) has been performed for multiple duodenal gastrinomas. RESULTS: Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients (87.5%); that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR (although in 2 patients (33.3%) second LR was performed for recurrence of duodenal gastrinoma), and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the resected specimens revealed co-existence of pancreatic gastrinoma with duodenal gastrinoma in 2 of 16 patients (13%), and G cell hyperplasia and/or microgastrinoma in the duodenal Brunner's gland was revealed in all of 7 duodenal specimens after PPTD. CONCLUSION: Aggressive resection surgery based on accurate localization with the SASI test was useful for biochemical cure of gastrinoma in patients with MEN 1. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/21455335/Biochemically_curative_surgery_for_gastrinoma_in_multiple_endocrine_neoplasia_type_1_patients_ L2 - http://www.wjgnet.com/1007-9327/full/v17/i10/1343.htm DB - PRIME DP - Unbound Medicine ER -