Factors affecting natural history of gastrinoma (Zollinger-Ellison Syndrome
) are not yet entirely understood, although much valid information has been
gained in the last two decades. Prognostic factors are: a) adequate reduct
ion of gastric acid overproduction insuring symptomatic control and healing
of ulcerative lesions; b) inclusion in multiple endocrine neoplasia-1 synd
rome rendering gastrinoma surgery rarely indicated and scarcely efficacious
; c) size location and spread of the tumoural process(es) conditioning rese
ctability and risk of metachronous liver and extra-abdominal metastases; d)
hepatic and bone metastases, major determinants of death; e) development o
f paraneoplastic Cushing rapidly out of control and causing death within a
short period of time; f) development of fundic EC-Lomas in Zollinger-Elliso
n Syndrome-multiple endocrine neoplasia-l patients, generally undergoing be
nign course but possibly leading to lymph node and (exceptionally) to liver
metastases and, sometimes, to total gastrectomy; g) experience of medical
and surgical teams which are also most important in order to achieve no ope
rative mortality and minimal post-operative complications.