Gastrinoma: factors influencing prognosis.

The gastrinoma remains the only endocrine-producing pancreatic tumor for which early surgical intervention is not uniformly advised. It should be possible after 30 years to determine the factors that appear to influence survival. Forty patients who underwent surgery 10 years or more ago were reviewed in an effort to identify factors at operation and the type of surgical procedure that influence survival. Because the total number of patients is small, conclusions based on statistics are not justified; however, certain trends have become clear. Favorable factors at surgery were the presence of a verified submucosal duodenal tumor, the presence of multiple endocrine neoplasia, or the failure to find tumor. Unfavorable factors were the presence of liver and/or lymph node metastases and/or a verified sporadic, nonfamilial pancreatic tumor. Thirty-four of the 40 patients underwent total gastrectomy, and 18 of these patients also underwent hemipancreatectomy, while six underwent other procedures less than total gastrectomy. The 10-year survival rate was 50%. The long-term quality of life in surviving patients who underwent total gastrectomy supports the original recommendation of total gastrectomy.