The role of routine surgical exploration for resection/cure in patients with Zollinger-Ellison syndrome has been controversial since the original description of this disease in 1955.
This controversy continues, partly because medical therapy for acid hypersecretion is so effective.
There is continued controversy in large part because no studies have shown an effect of tumor resection on survival.
Dr Jeffrey Norton and colleagues evaluated the routine use of surgical exploration for gastrinoma resection/cure in 160 patients with Zollinger-Ellison syndrome
The research team assessed survival in these patients and compared results with 35 Zollinger-Ellison syndrome patients who did not undergo surgery.
|At surgery, 94% had a tumor removed|
|Annals of Surgery|
All patients had preoperative computed tomography, magnetic resonance imaging, and ultrasound.
If unclear, angiography and somatostatin receptor scintigraphy was evaluated since 1994 to determine resectability.
At surgery, all had the same standard Zollinger-Ellison syndrome operation.
The researchers evaluated all patients yearly with imaging studies and disease activity studies.
The 35 nonsurgical patients did not differ from the 160 operated in clinical, laboratory, or tumor imaging results.
The team noted that 2 groups did not differ in follow-up time since initial evaluation.
At surgery, 94% had a tumor removed, 51% were cured immediately, and 41% at last follow-up.
The researchers observed that significantly more unoperated patients developed liver metastases, died of any cause, or died a disease-related death.
Survival plots showed operated patients had a better disease-related survival.
However, the team found no difference in non-disease-related survival.
The researchers found that the 15-year disease-related survival was 98% for operated and 74% for unoperated.
Dr Norton's team commented, “These results demonstrate that routine surgical exploration increases survival in patients with Zollinger-Ellison syndrome by increasing disease-related survival and decreasing the development of advanced disease.”
“Routine surgical exploration should be performed in Zollinger-Ellison syndrome patients.”