Clinical characteristics, complications and outcomes of 27 prospectively collected MEN1 patients with biochemically proven
gastrinoma, who underwent surgery, were analyzed with special regard to the
gastrinoma type and the initial operative procedure.
RESULTS: Twenty-two (81%) patients with
gastrinoma in MEN1 had duodenal
gastrinomas and 5 patients (19%) had pancreatic
gastrinomas. At the time of diagnosis, 21 (77%)
gastrinomas were malignant (18 duodenal, 3 pancreatic), but distant
metastases were only present in 4 (15%) patients. Patients with pancreatic
gastrinomas underwent either distal pancreatic resections or
gastrinoma enucleation with
lymphadenectomy, 2 patients also had synchronous resections of liver
metastases. One of these patients was biochemically cured after a median of 136 (77-312) months. Thirteen patients with duodenal
gastrinomas underwent PD resections (group 1, partial PD [n = 11], total PD [n = 2]), whereas 9 patients had no-PD resections (group 2) as initial operative procedure. Perioperative morbidity and mortality, including postoperative diabetes, differed not significantly between groups (P > 0.5). All patients of group 1 and 5 of 9 (55%) patients of group 2 had a negative
secretin test at hospital discharge. However, after a median follow-up of 136 (3-276) months, 12 (92%) patients of group 1 were still normogastrinemic compared to only 3 of 9 (33%) patients of group 2 (P = 0.023). Three (33%) patients of group 2 had to undergo up to 3 reoperations for recurrent or metastatic disease compared to none of group 1.
CONCLUSIONS: