Surgery or

Surgical treatment of gastrinoma depends on whether the lesion is sporadic or a part of the MEN I syndrome. Several studies have shown that the long-term cure rates after surgery for patients with gastrinoma associated with MEN I are very low (< 10%) (Table 26-3). Most authorities currently recommend that surgery not be performed for lesions < 2 to 2.5 cm in patients with gastrinoma and MEN I. Lesions > 2.5 cm are to be excised, as they are associated with a higher risk of liver metastases. Surgery in this group is performed not for biochemical cure, but for prevention of disease progression.

In contrast, sporadic gastrinoma is associated with postoperative eugastrinemia rates of 60% (immediate postoperative), 50% (5 years), and 35% (10 years). In addition, exploration for sporadic gastrinoma identifies the lesion in almost 90% of the patients, even if the preoperative localization studies fail. Therefore, routine surgical exploration is recommended for all patients with sporadic gastrinoma, except for those patients with clearly unresectable metastatic disease.

TABLE 26-3. Cure Rates for MEN 1 Gastrinoma

Study Number of Patients Cure Rate (%)

Farley (1992) 1B 0

Melvin (1993) 1B B

Norton (1999) 2B B

Norton (2001) 4B 0

Constipation Prescription

Constipation Prescription

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