title: Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma.
abstract: BACKGROUND
  The study was undertaken to determine prognostic factors and the value of systematic lymphadenectomy on survival in sporadic gastrinoma.
  
  
  METHODS
  Patients with sporadic gastrinoma who underwent initial surgery during a 21-year period in two tertiary referral centres were analysed retrospectively with respect to clinical characteristics, operative procedures and outcome.
  
  
  RESULTS
  Forty-eight patients with a median age of 52 (range 22-73) years were analysed. Some 18 patients had pancreatic and 26 had duodenal gastrinomas, whereas the primary tumour remained unidentified in four patients. After a median postoperative follow-up of 83 (range 3-296) months, 20 patients had no evidence of disease, 13 patients were alive with disease, 11 patients had died from the disease and four had died from unrelated causes. In 41 patients who underwent potentially curative surgery, systematic lymphadenectomy with excision of more than ten lymph nodes resulted in a higher rate of biochemical cure after surgery than no or selective lymphadenectomy (13 of 13 versus 18 of 28 patients; P = 0·017), with a trend towards prolonged disease specific survival (P = 0·062) and disease-free survival (P = 0·120), and a reduced risk of death (0 of 13 versus 7 of 24 patients; P = 0·037). Negative prognostic factors for disease specific survival were pancreatic location (P = 0·029), tumour size equal to or larger than 25 mm (P = 0·003), Ki-67 index more than 5 per cent (P < 0·001), preoperative gastrin level 3000 pg/ml or more (P = 0·003) and liver metastases (P < 0·001). Sex, age, type of surgery and presence of lymph node metastases had no influence on disease free or disease specific survival.
  
  
  CONCLUSIONS
  In sporadic gastrinoma, systematic lymphadenectomy during initial surgery may reduce the risk of persistent disease and improve survival.
authors.affiliation: Department of Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
authors.forename: D K
authors.initials: DK
authors.lastname: Bartsch
authors.forename: J
authors.initials: J
authors.lastname: Waldmann
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.forename: L
authors.initials: L
authors.lastname: Boninsegna
authors.forename: C L
authors.initials: CL
authors.lastname: Lopez
authors.forename: S
authors.initials: S
authors.lastname: Partelli
authors.forename: M
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D015408:Gastrinoma / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015043:Zollinger-Ellison Syndrome / Q000209:etiology / Q000401:mortality