Table 3.
Results of curative surgery for gastrinomas in MEN type1 patients
| # | Age y.o sex | Operation for gastrinoma | Location of gastrinoma (size: mm) | Mets. of gastrinoma | Nonfunctioning panc- NET size | HPT age at surg: y.o | Pit- NET age at surg: y.o | Prognosis, recurrence of gastrinoma | ||
|---|---|---|---|---|---|---|---|---|---|---|
| D | P | N | L | |||||||
| 1 |
44 M |
PD | 1 (5) | 0 | 1 | 0 |
5 1-2 mm |
– |
+ 41,42 |
No recurrence 18 years post-op, alive and well, then lost to follow-up |
| 2 |
39 F |
PD |
7 (2–7) |
0 | 1 | 0 |
6 1-2 mm |
+ 39 |
– |
No recurrence 4 years post-op, died of other disease |
| 3 |
21 M |
PD |
1 (10) |
0 | 0 | 0 | 0 | – |
+ 21 |
No recurrence 25 years post-op, alive and well |
| 4 |
49 M |
DX, DP |
9 (1–7) |
0 | 0 | 0 |
1 15 mm (gluc) |
+ 47 |
+ 59 |
No recurrence 25 years post-op, alive and well |
| 5 |
61 F |
DX (twice), P-Enucl |
4 (1–4) |
2 | 1 | 0 |
2 3 mm, 5 mm |
+ 55 |
– |
No recurrence 14 years post-op, alive and well, then lost to follow-up |
| 6 |
56 F |
DX(twice) P-Enucl |
2 (1–3) |
0 | 0 | 0 |
3 3-10 mm |
+ 55 |
– |
No recurrence 21 years post-op, alive and well |
| 7 |
44 F |
DX |
1 (9) |
0 | 0 | 0 |
1 (PD 36 yo) 8 cm |
+ 44 |
– |
No recurrence 21 years post-op, alive and well |
| 8 | 33 M |
DX, DP |
1 (10) | 0 | 1 | 0 |
Multiple gluc |
+ 23, 33 |
+ 50 |
No recurrence 19 years post-op, alive with post-craniotomy complications |
| 9 |
54 F |
DX, |
2 (6, 12) |
1 15 mm |
3 | 0 |
Multiple insulinomas (DP:23 y) |
+ 34 |
+ Γknife 23, 40 |
No recurrence 12 years post-op, alive and well |
| 10 |
59 F |
DX |
1 (7) |
0 | 1 | 0 | 0 |
+ 59 |
+ |
No recurrence 12 years post-op, alive and well |
| 11 |
51 F |
PPTD |
Multi (1–4) |
0 | 2 | + – | 9 |
+ 51 |
– | Died of liver mets. 6 years post-op, probably as a result of non-curative surgery due to liver metastases |
| 12 |
30 M |
PPTD, DP |
1 (5) |
0 | 0 | 0 | 2 |
+ 30 |
+ | 18 years post-op, alive with liver mets |
| 13 |
32 M |
PPTD |
2 (5, 7) |
0 | 1 | 0 |
Multi 1-5 mm |
+ 31 |
+ |
No recurrence 18 years post-op, alive and well |
| 14 |
48 F |
PPTD |
Multi (1–5) |
0 | 1 | 0 |
Multi 2-9 mm |
+ 48 |
– | 15 years post-op, alive with liver mets controlled by somatostatin analog |
| 15 |
33 M |
PPTD |
1 (8) |
0 | 2 | 0 |
Multi 1-5 mm |
+ 26 |
– | 14 years post-op, alive with liver mets. after resection of NETG2 of thymus (49 yo) |
| 16 |
57 F |
PPTD |
7 (< 2) |
0 | 1 | 0 | 0 |
+ 56 |
– |
No recurrence 5 years post-op, died of other disease |
| 17 |
32 M |
PPTD Enucl, DP |
12 (2–4) |
2 | 3 | 0 |
Multi < 5 mm |
+ 32 |
– |
12 years post-op, alive and well but with #16 LN met |
| 18 |
68 M |
PPTD |
8 (2–13) |
0 | 3 | 0 |
3 (gluc) |
+ 68 |
+ |
No recurrence 10 years post-op, alive and well |
| 19 |
62 M |
PPTD |
2 (3–5) |
0 | 0 | 0 |
Multi < 10 mm |
+ 42 |
+ |
No recurrence 8 years post-op, alive and well |
| 20 |
47 M |
PPTD |
1 (7) |
0 | 0 | 0 |
Multi < 13 mm |
+ 47 |
– |
No recurrence, 4 years post-op, alive and well |
Details of the patients with multiple endocrine neoplasia type 1 (MEN1) who underwent resection surgery for gastrinomas by our team
All 20 patients (100%) had duodenal gastrinomas, which were multiple in 12 (60%). Duodenal gastrinomas were 7 mm or less in diameter in 14 patients (70%) and more than 10 mm in diameter in 2 patients (10%). Pancreatic gastrinomas co-existed in 3 patients (15%). Lymph node metastases were detected in 13 patients (65%). Re-operation for recurrent duodenal gastrinomas was performed in 2 patients (10%). Biochemical cure of the gastrinomas was achieved in 15 patients (75%), who have remained well without evidence of recurrence of gastrinomas for 15.0±7.1 years (4–25 years). Two patients (10%) died of other diseases, 4 and 5 years postoperatively, respectively. Hepatic metastases developed postoperatively in four patients (20%). One of them died of progression of the gastrinomas 6 years postoperatively, and the other three have remained well for 14, 15, and 18 years respectively, on anti-NET medicines. Lymph node metastasis developed postoperatively in one patient (5%) who has remained well on anti-NET medicines for 12 years. For distant metastases that developed postoperatively, we gave somatostatin analogs, chemotherapy, molecular targeting agent or peptide receptor radionucleotide therapy (PRRT)
M male, F female, Panc- pancreatic, y.o. years old, HPT hyperparathyroidism, NET neuroendocrine tumors, PD pancreatoduodenectomy, DX partial duodenal resection, D duodenum, P pancreas, N lymph node metastasis, L hepatic metastasis, mets metastases, post-OP postoperatively, P-enucl enucleation of a pancreatic neuroendocrine tumor, multi multiple, DP distal pancreatectomy, γknif gamma-knife therapy, PPTD pancreas-preserving total duodenectomy, gluc glucagonoma, + positive, − negative, # No.