OUTCOME OF SURGICAL-TREATMENT FOR EXTRAPANCREATIC GASTRINOMAS

Since the availability of the H2-receptor antagonists (1978), seven pa tients admitted to the Department of Emergency Surgery, University of Pisa, with Zollinger-Ellison syndrome (ZES) sustained by extrapancreat ic gastrinomas underwent elective surgical treatment. There were four women and three men, with a mean age of 37.3 years (16 to 67 years of age). Preoperative localization studies included endoscopy of the uppe r part of the gastrointestinal tract, computed axial tomography, ultra sound, selective angiography and hepatic portal vein sampling for gast rin and were effective in four patients. In the other three patients, the localization of the gastrinoma was made at laparotomy. Four patien ts had gastrinomas of the duodenal and jejunal wall. Three underwent e xcisional operations, whereas the remnant was treated with pancreatodu odenectomy. In three of the patients, the location of the gastrinoma w as extrapancreatic and extraintestinal, and surgical treatment consist ed of nodal excision (two patients) and hepatectomy. None of the patie nts had undergone a gastric operation in addition to tumorectomy proce dures. Soon after excisional operation, ZES recurred in one patient an d a second laparotomy with nodal excision resulted in a cure. On long term follow-up evaluation, ranging from 15 to 136 months (mean of 85.1 divided-by 37.3 months), no patients showed a recurrence of ZES. The possibility of extrapancreatic gastrinoma should be suspected in patie nts with sporadic ZES. The need for emergency surgical treatment in th ese patients is minimized by the medical control of the gastric secret ion that consents diagnostic studies for the preoperative localization of the gastrinoma. Even if only suspected, the site of the extrapancr eatic gastrinoma has an increased chance to be identified at operation . This consents to remove gastrinomas mostly by a minimal excisional p rocedure resulting in the normalization of gastric secretion and the p revention of malignant evolution of these tumors.