[The role of total gastrectomy in the management of gastrinoma syndrome].
Total gastrectomy used to be considered as a standard operation in the surgical treatment for gastrinoma syndrome. Although this end organ resection is a good palliation, to cure this ulcerogenic disease, gastrinoma resection is preferred. It remains a question if a total gastrectomy is necessary when a gastrinoma is found and resected. In a period of 12 years, nine out of 17 patients with gastrinoma syndrome were surgically treated. Fifteen gastrinomas were removed without histologic evidence of malignancy. Total gastrectomy was added in three, Whipple's operation was done in one and tumor resection alone in five. Serial examination of the resected stomach didn't find any gastrinoma. Eight gastrinomas of seven patients were found located in the pancreas, duodenum and lymph nodes within the gastrinoma triangle. These patients except one were followed up for six months to five years (mean 32 months). One died of post-operative hepatic failure, and one died of hypophysectomy for a co-existent huge prolactinoma (MEN I) four years later. Cure of the disease in terms of normal fasting serum gastrin levels, symptom free without medication, endoscopic evidence of healed ulcer, and a negative conversion of secretin provocative test was found in 2/3 of the patients with additional total gastrectomy, and 4/6 of the others. All cured patients had their gastrinomas located in the gastrinoma triangle, and six of the seven (85.7%) patients with gastrinomas in the triangle were cured. It is our conclusion that total gastrectomy was retrospectively unnecessary in most of the patients with gastrinomas in the gastrinoma triangle. Staged operations should be planned.(ABSTRACT TRUNCATED AT 250 WORDS)
Lin
J M
JM
Department of Surgery, Veterans General Hospitals-Taipei.
Lee
C H
CH
P'eng
F K
FK
Wang
H C
HC
Lee
C
C
Lui
W Y
WY
D000328:Adult; D005260:Female; D005743:Gastrectomy; D015408:Gastrinoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*