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Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma.
Br J Surg. 2012 Sep; 99(9):1234-40.BJ

Abstract

BACKGROUND

The study was undertaken to determine prognostic factors and the value of systematic lymphadenectomy on survival in sporadic gastrinoma.

METHODS

Patients with sporadic gastrinoma who underwent initial surgery during a 21-year period in two tertiary referral centres were analysed retrospectively with respect to clinical characteristics, operative procedures and outcome.

RESULTS

Forty-eight patients with a median age of 52 (range 22-73) years were analysed. Some 18 patients had pancreatic and 26 had duodenal gastrinomas, whereas the primary tumour remained unidentified in four patients. After a median postoperative follow-up of 83 (range 3-296) months, 20 patients had no evidence of disease, 13 patients were alive with disease, 11 patients had died from the disease and four had died from unrelated causes. In 41 patients who underwent potentially curative surgery, systematic lymphadenectomy with excision of more than ten lymph nodes resulted in a higher rate of biochemical cure after surgery than no or selective lymphadenectomy (13 of 13 versus 18 of 28 patients; P = 0·017), with a trend towards prolonged disease specific survival (P = 0·062) and disease-free survival (P = 0·120), and a reduced risk of death (0 of 13 versus 7 of 24 patients; P = 0·037). Negative prognostic factors for disease specific survival were pancreatic location (P = 0·029), tumour size equal to or larger than 25 mm (P = 0·003), Ki-67 index more than 5 per cent (P < 0·001), preoperative gastrin level 3000 pg/ml or more (P = 0·003) and liver metastases (P < 0·001). Sex, age, type of surgery and presence of lymph node metastases had no influence on disease free or disease specific survival.

CONCLUSION

In sporadic gastrinoma, systematic lymphadenectomy during initial surgery may reduce the risk of persistent disease and improve survival.

Authors+Show Affiliations

Department of Surgery, University Hospital Giessen and Marburg, Marburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

22864882

Citation

Bartsch, D K., et al. "Impact of Lymphadenectomy On Survival After Surgery for Sporadic Gastrinoma." The British Journal of Surgery, vol. 99, no. 9, 2012, pp. 1234-40.
Bartsch DK, Waldmann J, Fendrich V, et al. Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma. Br J Surg. 2012;99(9):1234-40.
Bartsch, D. K., Waldmann, J., Fendrich, V., Boninsegna, L., Lopez, C. L., Partelli, S., & Falconi, M. (2012). Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma. The British Journal of Surgery, 99(9), 1234-40. https://doi.org/10.1002/bjs.8843
Bartsch DK, et al. Impact of Lymphadenectomy On Survival After Surgery for Sporadic Gastrinoma. Br J Surg. 2012;99(9):1234-40. PubMed PMID: 22864882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma. AU - Bartsch,D K, AU - Waldmann,J, AU - Fendrich,V, AU - Boninsegna,L, AU - Lopez,C L, AU - Partelli,S, AU - Falconi,M, PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/10/16/medline SP - 1234 EP - 40 JF - The British journal of surgery JO - Br J Surg VL - 99 IS - 9 N2 - BACKGROUND: The study was undertaken to determine prognostic factors and the value of systematic lymphadenectomy on survival in sporadic gastrinoma. METHODS: Patients with sporadic gastrinoma who underwent initial surgery during a 21-year period in two tertiary referral centres were analysed retrospectively with respect to clinical characteristics, operative procedures and outcome. RESULTS: Forty-eight patients with a median age of 52 (range 22-73) years were analysed. Some 18 patients had pancreatic and 26 had duodenal gastrinomas, whereas the primary tumour remained unidentified in four patients. After a median postoperative follow-up of 83 (range 3-296) months, 20 patients had no evidence of disease, 13 patients were alive with disease, 11 patients had died from the disease and four had died from unrelated causes. In 41 patients who underwent potentially curative surgery, systematic lymphadenectomy with excision of more than ten lymph nodes resulted in a higher rate of biochemical cure after surgery than no or selective lymphadenectomy (13 of 13 versus 18 of 28 patients; P = 0·017), with a trend towards prolonged disease specific survival (P = 0·062) and disease-free survival (P = 0·120), and a reduced risk of death (0 of 13 versus 7 of 24 patients; P = 0·037). Negative prognostic factors for disease specific survival were pancreatic location (P = 0·029), tumour size equal to or larger than 25 mm (P = 0·003), Ki-67 index more than 5 per cent (P < 0·001), preoperative gastrin level 3000 pg/ml or more (P = 0·003) and liver metastases (P < 0·001). Sex, age, type of surgery and presence of lymph node metastases had no influence on disease free or disease specific survival. CONCLUSION: In sporadic gastrinoma, systematic lymphadenectomy during initial surgery may reduce the risk of persistent disease and improve survival. SN - 1365-2168 UR - https://www.unboundmedicine.com/medline/citation/22864882/Impact_of_lymphadenectomy_on_survival_after_surgery_for_sporadic_gastrinoma_ L2 - https://doi.org/10.1002/bjs.8843 DB - PRIME DP - Unbound Medicine ER -