PMID- 16794390
OWN - NLM
STAT- MEDLINE
DCOM- 20060823
LR  - 20181113
IS  - 0003-4932 (Print)
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 244
IP  - 1
DP  - 2006 Jul
TI  - Pancreatectomy in multiple endocrine neoplasia type 1-related gastrinomas and 
      pancreatic endocrine neoplasias.
PG  - 61-70
AB  - OBJECTIVE: The aim of this study was to evaluate the results of pancreatic 
      resection in pancreatic endocrine neoplasias (PENs) in patients affected by 
      multiple endocrine neoplasia type 1 (MEN1) syndrome. BACKGROUND: Since these 
      tumors often show an indolent course, the role of diagnostic procedures and type 
      of surgical approach are controversial. Experience with new diagnostic approaches 
      and more aggressive surgery is still limited. METHODS: Sixteen MEN1 patients were 
      referred to our Surgical Unit (1992-2003) and were operated on for the 
      indications of hypergastrinism, hypoglycemia, and/or pancreatic endocrine 
      neoplasias larger than 1 cm. Zollinger-Ellison syndrome (ZES) was present in 13 
      patients, 2 of whom experienced a recurrence after previous surgery. Preoperative 
      tumor localization was carried out using ultrasonography (US), computed 
      tomography (CT), endoscopic ultrasonography (EUS), somatostatin receptor 
      scintigraphy (SSRS), or selective arterial secretin injection (SASI). Rapid 
      intraoperative gastrin measurement (IGM) was carried out in 8 patients, and 1 
      patient also underwent an intraoperative secretin provocative test. RESULTS: 
      Either pancreatoduodenectomy (PD) or total pancreatectomy (TP) or distal 
      pancreatectomy was performed. There was no postoperative mortality; 37% 
      complications included pancreatic (27%) and biliary (6%) fistulas, abdominal 
      collection (6%), and acute pancreatitis (6%). EUS and SSRS were the most 
      sensitive preoperative imaging techniques. At follow-up, 10 of 13 
      hypergastrinemic patients (77%) are currently eugastrinemic with negative 
      secretin provocative test, while 3 are showing a recurrence of the disease. All 
      patients affected by insulinoma were cured. CONCLUSIONS: MEN1 tumors should be 
      considered surgically curable diseases. IGM may be of value in the assessment of 
      surgical cure. Our experience suggests that PD is superior to less radical 
      surgical approaches in providing cure with limited morbidity in MEN1 gastrinomas 
      and pancreatic neoplasias.
FAU - Tonelli, Francesco
AU  - Tonelli F
AD  - Department of Clinical Physiopathology, University of Florence, Medical School, 
      Florence, Italy. f.tonelli@dfc.unifi.it
FAU - Fratini, Geri
AU  - Fratini G
FAU - Nesi, Gabriella
AU  - Nesi G
FAU - Tommasi, Maria Silvia
AU  - Tommasi MS
FAU - Batignani, Giacomo
AU  - Batignani G
FAU - Falchetti, Alberto
AU  - Falchetti A
FAU - Brandi, Maria Luisa
AU  - Brandi ML
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Adult
MH  - Female
MH  - Gastrinoma/diagnosis/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/diagnosis/*surgery
MH  - *Pancreatectomy
MH  - Pancreatic Neoplasms/diagnosis/*surgery
MH  - Pancreaticoduodenectomy
MH  - Postoperative Complications
MH  - Zollinger-Ellison Syndrome/diagnosis/surgery
PMC - PMC1570585
EDAT- 2006/06/24 09:00
MHDA- 2006/08/24 09:00
PMCR- 2007/01/01
CRDT- 2006/06/24 09:00
PHST- 2006/06/24 09:00 [pubmed]
PHST- 2006/08/24 09:00 [medline]
PHST- 2006/06/24 09:00 [entrez]
PHST- 2007/01/01 00:00 [pmc-release]
AID - 00000658-200607000-00010 [pii]
AID - 0000658-200607000-00010 [pii]
AID - 10.1097/01.sla.0000218073.77254.62 [doi]
PST - ppublish
SO  - Ann Surg. 2006 Jul;244(1):61-70. doi: 10.1097/01.sla.0000218073.77254.62.