American Association of Endocrine SurgeonsSurgical treatment of localized gastrinoma within the liver: A prospective study☆
Section snippets
Methods
Since 1982 we have prospectively studied 213 patients with ZES. The diagnosis was ascertained in all patients by measuring an elevated fasting serum level of gastrin and an elevated basal acid output. Further, a secretin stimulation test was confirmatory of the diagnosis in approximately 87%, as previously described.6 Each patient had gastric acid hypersecretion controlled medically with drugs to keep the basal acid output less than 10 mEq per hour (if no prior surgery to reduce acid output had
Patient demographics
Seventeen patients were identified with ZES who had imaging evidence of localized potentially resectable hepatic gastrinoma (n = 17, 25% of patients with liver gastrinoma). Two additional patients with diffuse bilobar liver tumor were included because they underwent hepatic surgery as part of an operative procedure intended not to remove all tumor, but rather to palliate another symptom related to tumor or tumor treatment. One patient had a large tumor abscess after chemoembolization and
Discussion
Patients with localized resectable liver metastases from gastrinoma are rare. In this prospective study of 213 patients with ZES, only 17 (8%) had localized liver gastrinoma and were candidates for surgical resection. Further, these patients represented only 25% of patients with liver metastases. Demographic data suggested that fasting serum levels of gastrin were markedly elevated in these patients and were higher than had been previously reported in patients with localized surgically
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Pancreatic endocrine tumors
2010, Seminars in OncologyCitation Excerpt :Today, 60% to 90% of gastrinomas are found in the gastrinoma triangle.65,67 In 2% to 24% of patients, gastrinomas are found at other locations, including the ovary, heart, liver and biliary tract, jejunum, renal capsule, omentum, and pylorus.68-71 Lymph node primary gastrinomas are reported in up to 11% of sporadic cases of ZES.63,69
Endocrine Tumors of the Pancreas and Gastrointestinal Tract
2010, Sleisenger and Fordtran’s Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features and PrintSurgical Management of Zollinger-Ellison Syndrome; State of the Art
2009, Surgical Clinics of North AmericaCitation Excerpt :There is evidence that resection of liver metastases improves survival, although it is difficult to conclude for certain that the demonstrated differences in survival are dependent on surgical treatment, and not the extent of disease itself.36,55 A significant percentage of patients with metastatic gastrinoma can undergo liver resections that result in removal of all known disease with 5-year survival up to 85%.56 In addition to possible survival benefit and surgical cure of metastatic disease, there may be benefit of cytoreductive surgery in ameliorating the functional endocrine tumor syndrome.57
A case of intrahepatic gastrinoma
2009, Annales d'EndocrinologieGastrointestinal Neuroendocrine Tumors: Pancreatic Endocrine Tumors
2008, GastroenterologyCitation Excerpt :In advance of surgery patients should be vaccinated against encapsulated microorganisms (pneumococcus, H influenza, meningococcus) in anticipation of a possible splenectomy and they should receive a bowel preparation in anticipation of an expected enterotomy (mandatory in the case of gastrinomas and other hormonal syndromes with a predilection for duodenal primaries).198,216–219 In general, all PETs (except imaged insulinomas) should be approached by laparotomy to permit an extensive exploration of the entire abdomen.113,203,219–221 An exception to this rule is surgery for insulinoma in non-MEN1 individuals because at least 85% of these tumors are benign, there usually is a single primary, and, if they can be localized preoperatively, laparoscopic resection is successful in 70%–100% of cases and its use hastens postoperative recovery.121,222–224
Gastrinoma
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Reprint requests: Jeffrey A. Norton, MD, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121-1598.