Analysis of factors associated with longterm (five or more years) cure in patients undergoing operation for Zollinger-Ellison syndrome

Background. Only 30% to 40% of patients with Zollinger-Ellison syndrome (ZE S) undergoing operation with curative intent have biochemical cures. The pu rpose of this analysis was to identify perioperative factors associated wit h long-term (greater than or equal to 5 years) biochemical cures. Methods. From December 1981 to September 1997, 128 patients with potentiall y curable ZES underwent 152 abdominal explorations with resection of all id entifiable disease. Of these, 31 outcomes were identified with documented c ures at greater than or equal to 5 years from operation and were compared w ith outcomes of 110 patients who were not cured. Univariate and multivariat e statistical analyses were performed. Results. The results of a normal immediate postoperative fasting serum gast rin and secretin stimulation test were significantly and independently corr elated with 5-year cure (P-2 = .005 and .0099, respectively). A diagnosis o f multiple endocrine neoplasia type 1 was significantly inversely correlate d with cure on univariate analysis (P-2 = .027). Gender; age, duration of s ymptoms, results of diagnostic tests, or results of imaging studies did not correlate with outcome. Conclusions. All patients with sporadic potentially curable ZES should unde rgo exploration because outcome is not associated with preoperative tests. Only 5% of patients with ZES and multiple endocrine neoplasia type 1 were c ured at 5 years. A normal fasting serum gastrin or secretin stimulation val ue value immediately postoperatively provides important prognostic informat ion.