IS REOPERATION FOR GASTRINOMA EXCISION INDICATED IN ZOLLINGER-ELLISONSYNDROME

Background. Surgical excision of gastrinomas in patients with Zollinge r-Ellison syndrome (ZES) decreases the incidence of hepatic metastases , but long-term biochemical cures are achieved in fewer than 30% of ca ses. A growing number of patients have persistent or recurrent disease after initial operation. The effect of reoperation in these patients has not been previously reported. Methods. From December 1982 to Augus t 1995, 120 patients with ZES underwent operation for gastrinoma resec tion. Seventy-eight patients had recurrent or persistent ZES after ope ration; 17 patients underwent 18 reoperations. After initial operation all patients underwent yearly functional and imaging studies. If a tu mor was unequivocally imaged, reexploration was done. Results. Five pa tients, all with sporadic disease, were disease free after operation, with a median follow-up of 28 months. Tumor was found in all 18 reoper ations and resected in 17. In patients with continuing disease-free in tervals, locations of gastrinomas included pancreatic head lymph nodes (three), liver metastasis (one), and pancreatic tail lymph node (one) . There were no deaths in the cured group; two patients in the group w ith persistent disease have died (median follow-up, 34 months). Conclu sions. Reoperation for gastrinoma excision resulted in elimination of disease in 30% of patients and should be considered for patients with imageable disease.