The focus of the surgical approach to gastrinomas is to prevent the development of metastatic disease in both types (sporadic and MEN I-related) and to achieve a biochemical cure in patients with sporadic gastrinoma. Even after resection, it is rarely possible to achieve biochemical cure in patients with MEN I. In patients with MEN I, the hypercalcemia is initially dealt with using para-thyroidectomy, followed by surgery for gastrinoma. Following parathyroidectomy, a decrease in basal and postsecretin stimulation gastrin levels is noted. Even when a curative resection is not possible for MEN I-associated gastrinoma, a debulking procedure can be considered. Debulking reduces the hormone producing cell mass and improves symptoms, enables more predictable medical management, and decreases tumor mass for cytotoxic therapy. Although controversial, one typical option involves enucleation of duodenal lesions and partial pancreatectomy or pancreatic enucleation. Some recommend this approach only if preoperative localization tests identify a lesion a 2 to 3 cm in size.
The treatment of ZE syndrome due to sporadic gastrinoma in the era of 1950 to 1980 often consisted of palliative gastrectomy to prevent life threatening bleeding and other complications of intractable peptic ulcer disease. Currently, PPIs can control acid related problems in almost all patients and therefore there is virtually no role for palliative surgery. Surgical intervention now consists of locating and excising the primary tumor with lymph node dissection and resection of metastases, if present. Ten-year disease-free survival and eugastrinemia can be obtained in about one-third of patients with sporadic gastrinoma.
Was this article helpful?
Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.