Management and outcome of patients with sporadic gastrinoma arising in the duodenum.
BACKGROUND
Primary duodenal gastrinomas are now recognized as a common etiology for patients with sporadic Zollinger Ellison Syndrome (ZES); however, the clinical and pathologic features of this condition and long-term outcome after operation are not well characterized.


METHODS
Between November 1982 and September 2000, 63 patients diagnosed with sporadic ZES underwent resection of a primary duodenal gastrinoma and regional nodal metastases with curative intent. Data from a prospectively maintained database were reviewed for clinical and pathologic parameters relating to primary tumor size, location, frequency of lymph node metastases, and disease-specific and disease-free survival.


RESULTS
There were 41 males and 22 females (mean age, 48.6 years). The majority of duodenal gastrinomas were in the first or second portions of the duodenum (83%). Tumor size ranged from 0.2 to 2.0 cm with 62% measuring less than 1.0 cm. Sixty percent of individuals had regional lymph node metastases identified primarily in proximity to the primary tumor. At a median 10-year follow-up, the overall disease-specific and disease-free survivals were 100% and 60%, respectively. Actuarial 10-year disease-free survival was significantly higher for patients without lymph node metastases versus those with lymph node metastases (78% versus 48%, P = 0.0137).


CONCLUSIONS
Duodenal gastrinomas in patients with sporadic ZES are frequently small, most commonly located in the proximal duodenum, and associated with regional lymph node metastases in 60%. Disease-free survival is lower for patients with regional lymph node metastases suggesting that a more systematic lymphadenectomy to extirpate occult disease may be indicated in this group.
Zogakis
Theresa G
TG
Surgery Branch, Center for Cancer Research, National Cancer Institute/National Institutes of Health, Building 10, Room 2B07, 10 Center Drive, Bethesda, MD 20892-1502, USA.
Gibril
Fathia
F
Libutti
Steven K
SK
Norton
Jeffrey A
JA
White
Donald E
DE
Jensen
Robert T
RT
Alexander
H Richard
HR
D000293:Adolescent; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D015408:Gastrinoma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D015043:Zollinger-Ellison Syndrome / Q000150:complications / Q000601:surgery*