Laparotomy and proximal gastric vagotomy in Zollinger-Ellison syndrome: results of a 16-year prospective study.

Abstract

OBJECTIVE:

Pharmacological control of gastric acid hypersecretion in the Zollinger-Ellison syndrome has steadily improved, but medical treatment does not address the underlying tumor. The objective of this study was to evaluate the long-term effectiveness of a surgical approach to both tumor and acid hypersecretion in 22 patients with the Zollinger-Ellison syndrome.

METHODS:

Patients underwent laparotomy to resect tumors, combined with vagotomy to reduce acid secretion, followed by postoperative antisecretory therapy, if necessary.

RESULTS:

No surgical mortality or serious morbidity occurred. Tumor was found at laparotomy in nine patients (41%) and during long-term follow-up in an additional two patients (9%). Ten-year survival is 81%, with a long-term cure rate of at least 14%. Most patients (86%) have had long-term inhibition of acid secretion. Eight patients have discontinued regular use of acid-inhibiting medications. Patients requiring medication need less of it, and they have an improved acid inhibitory response to medication for up to 16 yr after surgery.

CONCLUSION:

Cure of the Zollinger-Ellison syndrome is possible in a minority of patients. Acid secretion can be safely reduced in almost all patients with laparotomy/vagotomy, usually allowing discontinuation, or reduced dose, of acid-inhibiting drugs. Long-term survival and quality of life are generally excellent.

• Authors: K E McArthur, C T Richardson, C C Barnett, N Eshaghi, M J Smerud, R N McClelland, M Feldman
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 91 Issue 6 Pg. 1104-11 (Jun 1996) ISSN: 0002-9270 [Print] United States
• PMID: 8651153 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Topics

• Adolescent
• Adult
• Child
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Gastrinoma (diagnosis, mortality, surgery)
• Humans
• Laparotomy
• Life Tables
• Male
• Middle Aged
• Pancreatic Neoplasms (diagnosis, mortality, surgery)
• Prospective Studies
• Statistics, Nonparametric
• Texas (epidemiology)
• Vagotomy, Proximal Gastric
• Zollinger-Ellison Syndrome (diagnosis, mortality, surgery)