Resection of gastrinomas

Clifford Deveney, Karen Deveney, D. Stark, A. Moss, S. Stein, L. W. Way

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Exploratory laparotomy and a search for gastrinomas was performed in 52 patients with the Zollinger-Ellison syndrome (ZES). Gastrinoma tissue was resected in 11 patients (21%), 6 (12%) of whom appear to have been cured. After surgery, serum gastrin levels in these six patients have remained normal from 10 months to 10 years. In the 46 other patients, tumor was unresectable because of metastases or multiple primary tumors (21 patients; 40%) or inability to find the tumor at laparotomy (21 patients; 40%). Multiple pancreatic islet cell adenomata were found in six of seven patients with multiple endocrine neoplasia (MEN), indicating that patients with this condition usually have diffuse involvement of the pancreas. The results of CT scans correlated with findings at laparotomy in 13 of 16 patients. The smallest tumor detected by CT scans was 1 cm in diameter. CT technology is more accurate in finding gastrinomas now than in the past and has a useful role in preoperative evaluation. The possibility of resection should be seriously considered in every patient with Zollinger-Ellison syndrome. Abdominal CT scans, transhepatic portal venous sampling, and laparotomy should be used to find the tumor and to determine whether it is resectable. Using presently available methods, it should be possible to cure about 25% of patients with gastrinomas who do not have MEN and over 70% of those without MEN who appear to have a solitary tumor. Total pancreatectomy may be necessary to cure come patients with MEN, but that operation is rarely justified. The morbidity and mortality of surgical attempts at curing this disease have become minimal; we have had no deaths or serious complications following such operations in over 10 yrs. Total gastrectomy and indefinite use of H2-receptor blocking agents are the therapeutic options for patients with unresectable gastrinomas. Because of H2-receptor blocking agents fail to control acid secretion in many patients after several yrs of therapy, total gastrectomy is indicated in a large proportion of patients whose tumors cannot be resected. Total gastrectomy in patients with ZES is also safe using current techniques; our last death following this operation for ZES occurred 15 yrs ago.

Original languageEnglish (US)
Pages (from-to)546-553
Number of pages8
JournalAnnals of Surgery
Volume198
Issue number4
StatePublished - 1983
Externally publishedYes

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Gastrinoma
Multiple Endocrine Neoplasia
Zollinger-Ellison Syndrome
Laparotomy
Gastrectomy
Neoplasms
Histamine H2 Receptors
Islet Cell Adenoma
Pancreatectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Deveney, C., Deveney, K., Stark, D., Moss, A., Stein, S., & Way, L. W. (1983). Resection of gastrinomas. Annals of Surgery, 198(4), 546-553.

Resection of gastrinomas. / Deveney, Clifford; Deveney, Karen; Stark, D.; Moss, A.; Stein, S.; Way, L. W.

In: Annals of Surgery, Vol. 198, No. 4, 1983, p. 546-553.

Research output: Contribution to journalArticle

Deveney, C, Deveney, K, Stark, D, Moss, A, Stein, S & Way, LW 1983, 'Resection of gastrinomas', Annals of Surgery, vol. 198, no. 4, pp. 546-553.
Deveney C, Deveney K, Stark D, Moss A, Stein S, Way LW. Resection of gastrinomas. Annals of Surgery. 1983;198(4):546-553.
Deveney, Clifford ; Deveney, Karen ; Stark, D. ; Moss, A. ; Stein, S. ; Way, L. W. / Resection of gastrinomas. In: Annals of Surgery. 1983 ; Vol. 198, No. 4. pp. 546-553.
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