APPARENT LYMPH-NODE PRIMARY GASTRINOMA

Background. The existence of lymph node (LN) primary gastrinoma as a c ause of Zollinger-Ellison syndrome is controversial. We reviewed our e xperience with patients in whom gastrinomas were identified and excise d only from LNs. Methods. From 1982 to 1992, 110 patients with ZES und erwent exploration for gastrinoma and 21 (19%) had disease limited to one or more LNs. Standardized exploration included intraoperative ultr asonography, intraoperative endoscopy with transillumination, and expl oratory duodenotomy in 86%, 67%, and 24% of patients, respectively. Ea ch patient underwent yearly biochemical and radiologic follow-up. Resu lts. Thirteen patients (62%) with a median follow-up period of 5.8 yea rs had an initial biochemical cure, whereas eight patients (38%) with a median follow-up period of 3.6 years had persistent disease. Of the 13 patients whose condition initially returned to normal, four have ha d biochemical recurrence, with a median time to recurrence of 4.2 year s and a median follow-up period of 7.4 years. Nine patients (43%) rema in biochemically cured, with a median follow-up period of 5.3 years. C onclusions. Resection of apparent LN primary gastrinoma is warranted, because 43% of those who underwent resection had no evidence of diseas e, with a median follow-up period of 5.3 years.