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Surgery in Zollinger-Ellison syndrome alters the natural history of gastrinoma.
Ann Surg. 1994 Sep; 220(3):320-8; discussion 328-30.AnnS

Abstract

OBJECTIVE

The authors assessed the impact of gastrinoma resection on the subsequent development of hepatic metastases in Zollinger-Ellison syndrome.

SUMMARY BACKGROUND DATA

The symptoms of acid hypersecretion can be controlled medically in Zollinger-Ellison syndrome with high-dose pharmacologic therapy. The current role of surgery is curative excision of the gastrinoma. Because biochemical cure is obtained only in a portion of the patients and the neoplastic disease may be indolent in this syndrome, the ability of surgical resection of gastrinoma to alter or improve the subsequent development of hepatic metastases and mortality has not been defined.

METHODS

One hundred twenty-four patients with the biochemical diagnosis of Zollinger-Ellison syndrome and no hepatic metastases on initial imaging studies were evaluated. Ninety-eight patients underwent surgical exploration for curative gastrinoma resections while 26 patients were managed medically. Long-term follow-up regarding development of hepatic metastases and survival were evaluated.

RESULTS

Surgical exploration with gastrinoma excision resulted in a significantly decreased incidence of hepatic metastases 3% (3/98) compared with patients managed medically 23% (6/26) with comparable follow-up (p < 0.003). Two deaths due to metastatic gastrinoma occurred in the nonoperative group compared with no disease-specific deaths in the surgical group (p = 0.085).

CONCLUSIONS

For the patient with Zollinger-Ellison syndrome without metastatic disease, surgical exploration with attempted curative gastrinoma resection is recommended because it may alter the natural history of this syndrome.

Authors+Show Affiliations

Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

7916560

Citation

Fraker, D L., et al. "Surgery in Zollinger-Ellison Syndrome Alters the Natural History of Gastrinoma." Annals of Surgery, vol. 220, no. 3, 1994, pp. 320-8; discussion 328-30.
Fraker DL, Norton JA, Alexander HR, et al. Surgery in Zollinger-Ellison syndrome alters the natural history of gastrinoma. Ann Surg. 1994;220(3):320-8; discussion 328-30.
Fraker, D. L., Norton, J. A., Alexander, H. R., Venzon, D. J., & Jensen, R. T. (1994). Surgery in Zollinger-Ellison syndrome alters the natural history of gastrinoma. Annals of Surgery, 220(3), 320-8; discussion 328-30.
Fraker DL, et al. Surgery in Zollinger-Ellison Syndrome Alters the Natural History of Gastrinoma. Ann Surg. 1994;220(3):320-8; discussion 328-30. PubMed PMID: 7916560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery in Zollinger-Ellison syndrome alters the natural history of gastrinoma. AU - Fraker,D L, AU - Norton,J A, AU - Alexander,H R, AU - Venzon,D J, AU - Jensen,R T, PY - 1994/9/1/pubmed PY - 1994/9/1/medline PY - 1994/9/1/entrez SP - 320-8; discussion 328-30 JF - Annals of surgery JO - Ann. Surg. VL - 220 IS - 3 N2 - OBJECTIVE: The authors assessed the impact of gastrinoma resection on the subsequent development of hepatic metastases in Zollinger-Ellison syndrome. SUMMARY BACKGROUND DATA: The symptoms of acid hypersecretion can be controlled medically in Zollinger-Ellison syndrome with high-dose pharmacologic therapy. The current role of surgery is curative excision of the gastrinoma. Because biochemical cure is obtained only in a portion of the patients and the neoplastic disease may be indolent in this syndrome, the ability of surgical resection of gastrinoma to alter or improve the subsequent development of hepatic metastases and mortality has not been defined. METHODS: One hundred twenty-four patients with the biochemical diagnosis of Zollinger-Ellison syndrome and no hepatic metastases on initial imaging studies were evaluated. Ninety-eight patients underwent surgical exploration for curative gastrinoma resections while 26 patients were managed medically. Long-term follow-up regarding development of hepatic metastases and survival were evaluated. RESULTS: Surgical exploration with gastrinoma excision resulted in a significantly decreased incidence of hepatic metastases 3% (3/98) compared with patients managed medically 23% (6/26) with comparable follow-up (p < 0.003). Two deaths due to metastatic gastrinoma occurred in the nonoperative group compared with no disease-specific deaths in the surgical group (p = 0.085). CONCLUSIONS: For the patient with Zollinger-Ellison syndrome without metastatic disease, surgical exploration with attempted curative gastrinoma resection is recommended because it may alter the natural history of this syndrome. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/7916560/Surgery_in_Zollinger_Ellison_syndrome_alters_the_natural_history_of_gastrinoma_ L2 - http://Insights.ovid.com/pubmed?pmid=7916560 DB - PRIME DP - Unbound Medicine ER -