SURGICAL-TREATMENT OF THE GASTRINOMA ASSO CIATED WITH ZOLLINGER-ELLISON SYNDROME

During a period of 13,5 years 17 patients with a gastrinoma and an ass ociated Zollinger-Ellison syndrome were treated. In three patients (18 %) the gastrinoma was part of a multiple endocrine neoplasia type I (M EN I). The median interval from the initial symptoms to the definite d iagnosis was 5,0 years. During this interval seven patients (41%) unde rwent gastric surgery up to four times. The preoperative imaging studi es localized the primary tumor in only seven patients (41%). in five o f six diagnostic laparotomies the primary site of the tumor was identi fied and proved by pathologic work-up. The Surgical procedures (n = 13 ) included five resections of the pancreas (3 x pancreatic head, 2 x l eft pancreatic resection), two duodenal resections, three enucleations of the tumor and three palliative operations (hospital mortality: 0%) . Following laparotomy the gastrinoma could be histologically proved i n eleven of 17 patients (6 x pancreas, 4 x duodenum; 1 x in the hepato duodenal ligament). The rate of meta static spread as characteristic f eature of malignancy was 59%. After complete resection of the primary tumor (n = 8) none of these patients died because of the gastrinoma du ring the follow-up (median: 7,3 years). In the remaining patients thr ee deaths were caused by the metastatic spread of the gastrinoma. Cons idering the high rate of preceding operations, the high malignancy rat e and the excellent prognosis after RO-resection the diagnostic interv al in patients with ZES is too long, Despite the modern radiographic i maging the exploratory laparotomy is of high value in patients with ZE S.