Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1990 Jan;211(1):9–14. doi: 10.1097/00000658-199001000-00002

Gastrinoma excision for cure. A prospective analysis.

T J Howard 1, M J Zinner 1, B E Stabile 1, E Passaro Jr 1
PMCID: PMC1357886  PMID: 2294850

Abstract

The role of surgery in the treatment of gastrinoma is unclear. The purpose of this study was to determine prospectively the surgical cure rate using a controlled clinical trial. Eleven patients who fit the entry criteria underwent abdominal exploration and attempted tumor resection for cure. A historical control group was used for comparison. Cure was defined as: (1) normal serum gastrin level, (2) no response to intravenous secretin, (3) no symptoms when antisecretory medications are stopped, and (4) no tumor recurrence on follow-up examination. Tumors found in both groups tended to be small (1.5 cm vs. 2.2 cm), multiple (71% vs. 40%), and in lymph nodes (70% vs. 70%). All tumors identified were located anatomically within the gastrinoma triangle. Tumors were found in 10 of 11 patients (91%) in the study group, and significantly more patients had their tumors excised for cure as compared to controls (82% vs. 27%, p less than 0.05). The current prospective cure rate for gastrinoma is higher than previously appreciated and tumors within lymph nodes do not preclude curative resection.

Full text

PDF
12

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bornman P. C., Marks I. N., Mee A. S., Price S. Favourable response to conservative surgery for extra-pancreatic gastrinoma with lymph node metastases. Br J Surg. 1987 Mar;74(3):198–201. doi: 10.1002/bjs.1800740315. [DOI] [PubMed] [Google Scholar]
  2. Delcore R., Jr, Cheung L. Y., Friesen S. R. Outcome of lymph node involvement in patients with the Zollinger-Ellison syndrome. Ann Surg. 1988 Sep;208(3):291–298. doi: 10.1097/00000658-198809000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Deveney C. W., Deveney K. E., Stark D., Moss A., Stein S., Way L. W. Resection of gastrinomas. Ann Surg. 1983 Oct;198(4):546–553. doi: 10.1097/00000658-198310000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Deveney C. W., Deveney K. S., Way L. W. The Zollinger-Ellison syndrome--23 years later. Ann Surg. 1978 Sep;188(3):384–393. doi: 10.1097/00000658-197809000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dunnick N. R., Doppman J. L., Mills S. R., McCarthy D. M. Computed tomographic detection of nonbeta pancreatic islet cell tumors. Radiology. 1980 Apr;135(1):117–120. doi: 10.1148/radiology.135.1.6244605. [DOI] [PubMed] [Google Scholar]
  6. ELLISON E. H., WILSON S. D. THE ZOLLINGER-ELLISON SYNDROME: RE-APPRAISAL AND EVALUATION OF 260 REGISTERED CASES. Ann Surg. 1964 Sep;160:512–530. doi: 10.1097/00000658-196409000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ellison E. C., Carey L. C., Sparks J., O'Dorisio T. M., Mekhjian H. S., Fromkes J. J., Caldwell J. H., Thomas F. B. Early surgical treatment of gastrinoma. Am J Med. 1987 May 29;82(5B):17–24. doi: 10.1016/0002-9343(87)90423-2. [DOI] [PubMed] [Google Scholar]
  8. Fox P. S., Hofmann J. W., Wilson S. D., DeCosse J. J. Surgical management of the Zollinger-Ellison syndrome. Surg Clin North Am. 1974 Apr;54(2):395–407. doi: 10.1016/s0039-6109(16)40287-2. [DOI] [PubMed] [Google Scholar]
  9. Isenberg J. I., Walsh J. H., Grossman M. I. Zollinger-Ellison syndrome. Gastroenterology. 1973 Jul;65(1):140–165. [PubMed] [Google Scholar]
  10. Jensen R. T., Collen M. J., Pandol S. J., Allende H. D., Raufman J. P., Bissonnette B. M., Duncan W. C., Durgin P. L., Gillin J. C., Gardner J. D. Cimetidine-induced impotence and breast changes in patients with gastric hypersecretory states. N Engl J Med. 1983 Apr 14;308(15):883–887. doi: 10.1056/NEJM198304143081508. [DOI] [PubMed] [Google Scholar]
  11. Jensen R. T., Gardner J. D., Raufman J. P., Pandol S. J., Doppman J. L., Collen M. J. Zollinger-Ellison syndrome: current concepts and management. Ann Intern Med. 1983 Jan;98(1):59–75. doi: 10.7326/0003-4819-98-1-59. [DOI] [PubMed] [Google Scholar]
  12. Malagelada J. R., Edis A. J., Adson M. A., van Heerden J. A., Go V. L. Medical and surgical options in the management of patients with gastrinoma. Gastroenterology. 1983 Jun;84(6):1524–1532. [PubMed] [Google Scholar]
  13. McCarthy D. M. The place of surgery in the Zollinger-Ellison syndrome. N Engl J Med. 1980 Jun 12;302(24):1344–1347. doi: 10.1056/NEJM198006123022404. [DOI] [PubMed] [Google Scholar]
  14. Norton J. A., Doppman J. L., Collen M. J., Harmon J. W., Maton P. N., Gardner J. D., Jensen R. T. Prospective study of gastrinoma localization and resection in patients with Zollinger-Ellison syndrome. Ann Surg. 1986 Oct;204(4):468–479. doi: 10.1097/00000658-198610000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Norton J. A., Sugarbaker P. H., Doppman J. L., Wesley R. A., Maton P. N., Gardner J. D., Jensen R. T. Aggressive resection of metastatic disease in selected patients with malignant gastrinoma. Ann Surg. 1986 Apr;203(4):352–359. doi: 10.1097/00000658-198604000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Raufman J. P., Collins S. M., Pandol S. J., Korman L. Y., Collen M. J., Cornelius M. J., Feld M. K., McCarthy D. M., Gardner J. D., Jensen R. T. Reliability of symptoms in assessing control of gastric acid secretion in patients with Zollinger-Ellison syndrome. Gastroenterology. 1983 Jan;84(1):108–113. [PubMed] [Google Scholar]
  17. Richardson C. T., Peters M. N., Feldman M., McClelland R. N., Walsh J. H., Cooper K. A., Willeford G., Dickerman R. M., Fordtran J. S. Treatment of Zollinger-Ellison syndrome with exploratory laparotomy, proximal gastric vagotomy, and H2-receptor antagonists. A prospective study. Gastroenterology. 1985 Aug;89(2):357–367. doi: 10.1016/0016-5085(85)90337-3. [DOI] [PubMed] [Google Scholar]
  18. Stabile B. E., Morrow D. J., Passaro E., Jr The gastrinoma triangle: operative implications. Am J Surg. 1984 Jan;147(1):25–31. doi: 10.1016/0002-9610(84)90029-1. [DOI] [PubMed] [Google Scholar]
  19. Stabile B. E., Passaro E., Jr Benign and malignant gastrinoma. Am J Surg. 1985 Jan;149(1):144–150. doi: 10.1016/s0002-9610(85)80024-6. [DOI] [PubMed] [Google Scholar]
  20. Stage J. G., Stadil F. The clinical diagnosis of the Zollinger-Ellison syndrome. Scand J Gastroenterol Suppl. 1979;53:79–91. [PubMed] [Google Scholar]
  21. Stark D. D., Moss A. A., Goldberg H. I., Deveney C. W. CT of pancreatic islet cell tumors. Radiology. 1984 Feb;150(2):491–494. doi: 10.1148/radiology.150.2.6318260. [DOI] [PubMed] [Google Scholar]
  22. Thompson J. C., Lewis B. G., Wiener I., Townsend C. M., Jr The role of surgery in the Zollinger-Ellison syndrome. Ann Surg. 1983 May;197(5):594–607. doi: 10.1097/00000658-198305000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Vogel S. B., Wolfe M. M., McGuigan J. E., Hawkins I. F., Jr, Howard R. J., Woodward E. R. Localization and resection of gastrinomas in Zollinger-Ellison syndrome. Ann Surg. 1987 May;205(5):550–556. doi: 10.1097/00000658-198705000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wank S. A., Doppman J. L., Miller D. L., Collen M. J., Maton P. N., Vinayek R., Slaff J. I., Norton J. A., Gardner J. D., Jensen R. T. Prospective study of the ability of computed axial tomography to localize gastrinomas in patients with Zollinger-Ellison syndrome. Gastroenterology. 1987 Apr;92(4):905–912. doi: 10.1016/0016-5085(87)90963-2. [DOI] [PubMed] [Google Scholar]
  25. Wolfe M. M., Alexander R. W., McGuigan J. E. Extrapancreatic, extraintestinal gastrinoma: effective treatment by surgery. N Engl J Med. 1982 Jun 24;306(25):1533–1536. doi: 10.1056/NEJM198206243062506. [DOI] [PubMed] [Google Scholar]
  26. Wolfe M. M., Jensen R. T. Zollinger-Ellison syndrome. Current concepts in diagnosis and management. N Engl J Med. 1987 Nov 5;317(19):1200–1209. doi: 10.1056/NEJM198711053171907. [DOI] [PubMed] [Google Scholar]
  27. Yalow R. S., Berson S. A. Radioimmunoassay of gastrin. Gastroenterology. 1970 Jan;58(1):1–14. [PubMed] [Google Scholar]
  28. Zollinger R. M., Ellison E. C., Fabri P. J., Johnson J., Sparks J., Carey L. C. Primary peptic ulcerations of the jejunum associated with islet cell tumors. Twenty-five-year appraisal. Ann Surg. 1980 Sep;192(3):422–430. doi: 10.1097/00000658-198009000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES