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Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients

World Journal of Gastroenterology 2011年第10期17卷 1343-1353页

作者： Masayuki Imamura Izumi Komoto Shuichi Ota Takuya Hiratsuka Shinji Kosugi Ryuichiro Doi Masaaki Awane Naoya Inoue Department of Surgery Kansa Electric Power Company Hospital Departments of Surgery and Pathology Saiseikai Noe Hospital Medical Gene Research Center Graduate School of Medicine Kyoto University Department of Surgery Graduate School of MedicineKyoto University

AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 （MEN 1） and Zollinger-Ellison syndrome （ZES） underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors （NETs） between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test （SASI test） with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy （SRS） and other imaging methods such as computed tomography （CT） or magnetic resonance imaging （MRI）. The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery： pancreaticoduodenectomy （PD） was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes （LR）, and recently pancreas-preserving total duodenectomy （PPTD） has been performed for multiple duodenal gastrinomas. RESULTS： Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients （87.5%）; that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR （although in 2 patients （33.3%） second LR was performed for recurrence of duodenal gastri- noma）, and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the

关键词： Gastrinoma duodenopancreatic neuroendocrine tumors Multiple endocrine neoplasia type 1 Selective arterial secretagogue injection test 5omatostatin receptor scintigraphy pancreas-preserving total duode- nectomy Pancreaticoduodenectomy

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