SURGERY IN ZOLLINGER-ELLISON SYNDROME ALTERS THE NATURAL-HISTORY OF GASTRINOMA

Objective The authors assessed the impact of gastrinoma resection on t he subsequent development of hepatic metastases in Zollinger-Ellison s yndrome. Summary Background Data The symptoms of acid hypersecretion c an be controlled medically in Zollinger-Ellison syndrome with high-dos e pharmacologic therapy. The current role of surgery is curative excis ion of the gastrinoma. Because biochemical cure is obtained only in a portion of the patients and the neoplastic disease may be indolent in this syndrome, the ability of surgical resection of gastrinoma to alte r or improve the subsequent development of hepatic metastases and mort ality has not been defined. Methods One hundred twenty-four patients w ith the biochemical diagnosis of Zollinger-Ellison syndrome and no hep atic metastases on initial imaging studies were evaluated. Ninety-eigh t patients underwent surgical exploration for curative gastrinoma rese ctions white 26 patients were managed medically. Long-term follow-up r egarding development of hepatic metastases and survival were evaluated . Results Surgical exploration with gastrinoma excision resulted in a significantly decreased incidence of hepatic metastases 3% (3/98) comp ared with patients managed medically 23% (6/26) with comparable follow -up (p < 0.003). Two deaths due to metastatic gastrinoma occurred in t he nonoperative group compared with no disease-specific deaths in the surgical group (p = 0.085). Conclusions For the patient with Zollinger -Ellison syndrome without metastatic disease, surgical exploration wit h attempted curative gastrinoma resection is recommended because it ma y alter the natural history of this syndrome.