Faculty Collaboration Database

Achieving eugastrinemia in MEN1 patients: both duodenal inspection and formal lymph node dissection are important. Surgery 2011 Dec;150(6):1143-52

Date

12/06/2011

Pubmed ID

22136834

DOI

10.1016/j.surg.2011.09.028

Scopus ID

2-s2.0-82755182448 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND: Controversy exists regarding the role and extent of operation for patients with multiple endocrine neoplasia type 1 (MEN1) and hypergastrinemia.

METHODS: An institutional MEN1 database was reviewed to identify patients with evidence of hypergastrinemia. The relationship of extent of resection to achievement of eugastrinemia was evaluated.

RESULTS: Operation was performed in 20 patients with MEN1 and hypergastrinemia with a median follow-up of 71 months. Duodenal gastrinomas were identified in 85% of patients who underwent duodenal evaluation. Nodal metastases were identified in 80%. Patients who underwent anatomic regional lymph node dissection (RLND) had a median of 16 nodes removed, vs 1 in patients who did not undergo a formal regional lymphadenectomy. Eugastrinemia was achieved in 12 patients (60%), and 8 (40%) had persistent hypergastrinemia. Compared with patients with persistent hypergastrinemia, patients rendered eugastrinemic more often underwent duodenal evaluation (11/12 vs 2/8; P = .01) and RLND (11/12 vs 3/8; P = .03); there was no relationship between pancreatic resection and achievement of eugastrinemia (P = .32).

CONCLUSION: For patients with MEN1-associated hypergastrinemia selected for operative treatment, a strategy including duodenal evaluation and anatomic regional lymphadenectomy is associated with long-term eugastrinemia. In contrast, the extent of pancreatic resection should be dictated by the extent and distribution of pancreatic neuroendocrine neoplasms, rather than by the presence of hypergastrinemia.

Author List

Dickson PV, Rich TA, Xing Y, Cote GJ, Wang H, Perrier ND, Evans DB, Lee JE, Grubbs EG

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdomen
Adult
Duodenal Neoplasms
Female
Gastrinoma
Gastrins
Humans
Lymph Node Excision
Male
Middle Aged
Multiple Endocrine Neoplasia Type 1
Pancreatectomy
Pancreatic Neoplasms
Pancreaticoduodenectomy
Retrospective Studies
Treatment Outcome