BACKGROUND: Surgical excision of gastrinomas in patients with Zollinger-Ellison syndrome (ZES) decreases the incidence of hepatic metastases, but long-term biochemical cures are achieved in fewer than 30% of cases. A growing number of patients have persistent or recurrent disease after initial operation. The effect of reoperation in these patients has not been previously reported. METHODS: From December 1982 to August 1995, 120 patients with ZES underwent operation for gastrinoma resection. Seventy-eight patients had recurrent or persistent ZES after operation; 17 patients underwent 18 reoperations. After initial operation all patients underwent yearly functional and imaging studies. If a tumor was unequivocally imaged, reexploration was done. RESULTS: Five patients, all with sporadic disease, were disease free after operation, with a median follow-up of 28 months. Tumor was found in all 18 reoperations and resected in 17. In patients with continuing disease-free intervals, locations of gastrinomas included pancreatic head lymph nodes (three), liver metastasis (one), and pancreatic tail lymph node (one). There were no deaths in the cured group; two patients in the group with persistent disease have died (median follow-up, 34 months). CONCLUSIONS: Reoperation for gastrinoma excision resulted in elimination of disease in 30% of patients and should be considered for patients with imageable disease.
BACKGROUND: Surgical excision of gastrinomas in patients with Zollinger-Ellison syndrome (ZES) decreases the incidence of hepatic metastases, but long-term biochemical cures are achieved in fewer than 30% of cases. A growing number of patients have persistent or recurrent disease after initial operation. The effect of reoperation in these patients has not been previously reported. METHODS: From December 1982 to August 1995, 120 patients with ZES underwent operation for gastrinoma resection. Seventy-eight patients had recurrent or persistent ZES after operation; 17 patients underwent 18 reoperations. After initial operation all patients underwent yearly functional and imaging studies. If a tumor was unequivocally imaged, reexploration was done. RESULTS: Five patients, all with sporadic disease, were disease free after operation, with a median follow-up of 28 months. Tumor was found in all 18 reoperations and resected in 17. In patients with continuing disease-free intervals, locations of gastrinomas included pancreatic head lymph nodes (three), liver metastasis (one), and pancreatic tail lymph node (one). There were no deaths in the cured group; two patients in the group with persistent disease have died (median follow-up, 34 months). CONCLUSIONS: Reoperation for gastrinoma excision resulted in elimination of disease in 30% of patients and should be considered for patients with imageable disease.
Authors: Jeffrey A Norton; Douglas L Fraker; H R Alexander; Fathia Gibril; David J Liewehr; David J Venzon; Robert T Jensen Journal: Ann Surg Date: 2006-09 Impact factor: 12.969
Authors: Jeffrey A Norton; Edmund J Harris; Yijun Chen; Brendan C Visser; George A Poultsides; Pamela C Kunz; George A Fisher; Robert T Jensen Journal: Arch Surg Date: 2011-06
Authors: H R Alexander; D L Fraker; J A Norton; D L Bartlett; L Tio; S B Benjamin; J L Doppman; S U Goebel; J Serrano; F Gibril; R T Jensen Journal: Ann Surg Date: 1998-08 Impact factor: 12.969
Authors: Jeffrey A Norton; H Richard Alexander; Douglas L Fraker; David J Venzon; Fathia Gibril; Robert T Jensen Journal: Ann Surg Date: 2004-05 Impact factor: 12.969
Authors: Jeffrey A Norton; H Richard Alexander; Douglas L Fraker; David J Venzon; Fathia Gibril; Robert T Jensen Journal: Ann Surg Date: 2003-05 Impact factor: 12.969