Total
gastrectomy used to be considered as a standard operation in the surgical treatment for
gastrinoma syndrome. Although this end organ resection is a good palliation, to cure this ulcerogenic disease,
gastrinoma resection is preferred. It remains a question if a total
gastrectomy is necessary when a
gastrinoma is found and resected. In a period of 12 years, nine out of 17 patients with
gastrinoma syndrome were surgically treated. Fifteen
gastrinomas were removed without histologic evidence of
malignancy. Total
gastrectomy was added in three, Whipple's operation was done in one and
tumor resection alone in five. Serial examination of the resected stomach didn't find any
gastrinoma. Eight
gastrinomas of seven patients were found located in the pancreas, duodenum and lymph nodes within the
gastrinoma triangle. These patients except one were followed up for six months to five years (mean 32 months). One died of post-operative
hepatic failure, and one died of
hypophysectomy for a co-existent huge
prolactinoma (MEN I) four years later. Cure of the disease in terms of normal fasting serum
gastrin levels, symptom free without medication, endoscopic evidence of healed
ulcer, and a negative conversion of
secretin provocative test was found in 2/3 of the patients with additional total
gastrectomy, and 4/6 of the others. All cured patients had their
gastrinomas located in the
gastrinoma triangle, and six of the seven (85.7%) patients with
gastrinomas in the triangle were cured. It is our conclusion that total
gastrectomy was retrospectively unnecessary in most of the patients with
gastrinomas in the
gastrinoma triangle. Staged operations should be planned.(ABSTRACT TRUNCATED AT 250 WORDS)