The role of operation in patients with
Multiple Endocrine Neoplasia Type 1 (MEN-1) and
Zollinger-Ellison Syndrome (ZES) is controversial. Our institutional bias for this disease has, in general, been towards aggressive imaging and operative removal of localized
gastrinomas. Few studies have reported long-term outcomes in patients with MEN-1 and ZES. A single institution retrospective review of all patients with MEN-1 and ZES from 1970 to present was performed. Twelve patients were identified (median age = 37 years at diagnosis). The median follow-up was 18 years from diagnosis of ZES. Common symptoms associated with
gastrinoma in these patients were
diarrhea (n = 6),
abdominal pain (n = 4), and
nausea/
vomiting (n = 4). Most commonly identified sites of
gastrinoma were: pancreas (n = 10), duodenum (n = 4), lymph nodes (n = 3), and liver (n = 1). Fifteen celiotomies were performed in total (median = 1; range 0-3). Operative procedures performed included: distal
pancreatectomy (n = 4),
acid reducing procedure (n = 4), enucleation of pancreatic
gastrinoma (n = 3), duodenal resection (n = 3),
pancreaticoduodenectomy (n = 1), and other (n = 7). One patient had a transient biochemical cure after operation lasting 3 years. Only one patient in this series had documented liver
metastases of
gastrinoma and no patients expired of metastatic
gastrinoma. There was one postoperative patient death, secondary to respiratory arrest thought to be a result of aspiration or pulmonary
embolus. Three patients died of nondisease related causes, and seven patients were alive at the time of last follow-up. Operations rarely result in biochemical cures in patients with MEN-1 and ZES. In our experience, resection of localized
gastrinomas often did not require extended surgical resection and were associated with excellent long-term outcomes.