[Surgery for gastrinoma: Short and long-term results].
BACKGROUND
Zollinger-Ellison syndrome (Z-E) is characterized by gastrin-secreting tumors, responsible for causing refractory and recurrent peptic ulcers in the gastrointestinal tract. The optimal approach and the extension of tumor resection remains the subject of debate.


METHODS
During the period February 2005 and February 2014, 6 patients with Z-E underwent surgery, 4 men and 2 women with a median age 46.8 years (22-61). Two patients were affected with multiple endocrine neoplasia type-1 (MEN-1). Fasting gastrin levels greater than 200pg/ml (NV: <100) was diagnostic. Radiologic imaging to localize the lesion included octreoscan 6/6, computer tomography (CT) 6/6, and endoscopic ultrasonography (EUS) 1/6.


RESULTS
The octreoscan was positive in 5 patients. The CT localized the tumor in the pancreas in 2 patients, in the duodenum in 3 patients (1 confirmed by EUS) and between the common bile duct and vena cava in one patient. The laparoscopic approach was used in 4 patients, 2 patients converted to open surgery. The following surgical techniques were performed: 2 pylorus-preserving pancreatico-duodenectomy (PPPD), one spleen-preserving distal pancreatectomy, one duodenal nodular resection, 1 segmental duodenectomy and one extrapancreatic nodular resection. Pathological studies showed lymph nodes metástasis in 2 patients with pancreatic gastrinomas, and in one patient with duodenal gastrinoma. The median follow-up was 76,83 months (5-108) and all patients presented normal fasting gastrin levels.


CONCLUSIONS
Surgery may offer a cure in patients with Z-E. The laparoscopic approach remains limited to selected cases.
Departamento de Cirugía, Universidad de Barcelona, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: laurefcruz@gmail.com.
Laureano
L
Fernández-Cruz
Departamento de Cirugía, Universidad de Barcelona, Hospital Clínic de Barcelona, Barcelona, España.
Amalia
A
Pelegrina
D000328:Adult; D005260:Female; D015408:Gastrinoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D015043:Zollinger-Ellison Syndrome / Q000601:surgery*
Familiar gastrinoma; Gastrinoma esporádico; Gastrinoma familiar; Gastrinoma linfático primario; Laparoscopia; Laparoscopy; Lymph node gastrinoma; Sporadic gastrinoma