When the
Zollinger-Ellison syndrome was first identified, total
gastrectomy was proposed as the most effective treatment for the secretory manifestations of the syndrome. Recently, however, great enthusiasm has developed for medical treatment by means of H2-receptor antagonists. The authors have cared for 27 patients with the
Zollinger-Ellison syndrome at The University of Texas Medical Branch in the past 12 years and have been pleased with the results of total
gastrectomy, which was performed in 23 of the 27 patients (one patient refused operation and three patients had lesser gastric operations). Twenty-three patients underwent total
gastrectomy with Roux-en-Y esophagojejunostomy. There were no operative deaths. Primary
tumors were found in 17 patients, seven of whom also had metastatic
tumors. No
tumors were found in nine patients. Nine patients are dead; the actuarial survival rate for all patients was 75% at 5 years and 52%
at 10 years. Eleven of the 27 patients had the
multiple endocrine neoplasia I syndrome. Of the 18 survivors, only three have normal serum
gastrin levels, and all three had extrapancreatic
gastrinomas, one in peripancreatic lymph nodes, one in the liver, and one in a cystic
tumor attached to the stomach. Nutritional results were good to excellent, with a mean postoperative
weight loss of 14.7% (mean follow-up period was 45 months). The authors conclude that treatment of the hypersecretory problems of the
Zollinger-Ellison syndrome by total
gastrectomy is safe and dependable. Results compare well with those of long-term medical management, whose success is dependent upon serial favorable responses to a lifetime of repeated challenges.