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Prospective study of surgical resection of duodenal and pancreatic gastrinomas in multiple endocrine neoplasia type 1.
Surgery. 1995 Dec; 118(6):973-9; discussion 979-80.S

Abstract

BACKGROUND

The role of surgical resection of gastrinoma in multiple endocrine neoplasia type 1 (MEN 1) is controversial because of low biochemical cure rates, but with adequate duodenal exploration higher cure rates may be possible.

METHODS

We have prospectively evaluated this proposal in ten consecutive patients with MEN 1 and Zollinger-Ellison syndrome who underwent surgical exploration for gastrinoma resection including a detailed evaluation of the duodenum by palpation, intraoperative endoscopy with transillumination, and duodenotomy.

RESULTS

Duodenal tumors were present in seven patients. Six of seven patients had metastatic deposits in lymph nodes, and two of seven had synchronous pancreatic tumors. Three patients had a single duodenal tumor, one patient had two tumors, and three patients had more than 20 duodenal tumors. Positive gastrin staining by use of immunohistochemistry was seen in all duodenal tumors. None of these seven patients were biochemically cured. Of three patients with negative duodenal explorations, two had single pancreatic tumors removed and one had only lymph node gastrinoma. No patients were biochemically cured.

CONCLUSIONS

Not all patients with MEN 1 and Zollinger-Ellison syndrome have duodenal gastrinomas. In the 70% of patients with duodenal tumors, even extensive duodenal exploration with removal of positive lymph nodes does not result in cures because 86% of tumors had metastasized to lymph nodes and 43% of patients had large numbers of tumors.

Authors+Show Affiliations

Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892, 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

7491542

Citation

MacFarlane, M P., et al. "Prospective Study of Surgical Resection of Duodenal and Pancreatic Gastrinomas in Multiple Endocrine Neoplasia Type 1." Surgery, vol. 118, no. 6, 1995, pp. 973-9; discussion 979-80.
MacFarlane MP, Fraker DL, Alexander HR, et al. Prospective study of surgical resection of duodenal and pancreatic gastrinomas in multiple endocrine neoplasia type 1. Surgery. 1995;118(6):973-9; discussion 979-80.
MacFarlane, M. P., Fraker, D. L., Alexander, H. R., Norton, J. A., Lubensky, I., & Jensen, R. T. (1995). Prospective study of surgical resection of duodenal and pancreatic gastrinomas in multiple endocrine neoplasia type 1. Surgery, 118(6), 973-9; discussion 979-80.
MacFarlane MP, et al. Prospective Study of Surgical Resection of Duodenal and Pancreatic Gastrinomas in Multiple Endocrine Neoplasia Type 1. Surgery. 1995;118(6):973-9; discussion 979-80. PubMed PMID: 7491542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study of surgical resection of duodenal and pancreatic gastrinomas in multiple endocrine neoplasia type 1. AU - MacFarlane,M P, AU - Fraker,D L, AU - Alexander,H R, AU - Norton,J A, AU - Lubensky,I, AU - Jensen,R T, PY - 1995/12/1/pubmed PY - 1995/12/1/medline PY - 1995/12/1/entrez SP - 973-9; discussion 979-80 JF - Surgery JO - Surgery VL - 118 IS - 6 N2 - BACKGROUND: The role of surgical resection of gastrinoma in multiple endocrine neoplasia type 1 (MEN 1) is controversial because of low biochemical cure rates, but with adequate duodenal exploration higher cure rates may be possible. METHODS: We have prospectively evaluated this proposal in ten consecutive patients with MEN 1 and Zollinger-Ellison syndrome who underwent surgical exploration for gastrinoma resection including a detailed evaluation of the duodenum by palpation, intraoperative endoscopy with transillumination, and duodenotomy. RESULTS: Duodenal tumors were present in seven patients. Six of seven patients had metastatic deposits in lymph nodes, and two of seven had synchronous pancreatic tumors. Three patients had a single duodenal tumor, one patient had two tumors, and three patients had more than 20 duodenal tumors. Positive gastrin staining by use of immunohistochemistry was seen in all duodenal tumors. None of these seven patients were biochemically cured. Of three patients with negative duodenal explorations, two had single pancreatic tumors removed and one had only lymph node gastrinoma. No patients were biochemically cured. CONCLUSIONS: Not all patients with MEN 1 and Zollinger-Ellison syndrome have duodenal gastrinomas. In the 70% of patients with duodenal tumors, even extensive duodenal exploration with removal of positive lymph nodes does not result in cures because 86% of tumors had metastasized to lymph nodes and 43% of patients had large numbers of tumors. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/7491542/Prospective_study_of_surgical_resection_of_duodenal_and_pancreatic_gastrinomas_in_multiple_endocrine_neoplasia_type_1_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(05)80102-3 DB - PRIME DP - Unbound Medicine ER -