PMID- 21455335
OWN - NLM
STAT- MEDLINE
DCOM- 20110809
LR  - 20211020
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 17
IP  - 10
DP  - 2011 Mar 14
TI  - Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia 
      type 1 patients.
PG  - 1343-53
LID - 10.3748/wjg.v17.i10.1343 [doi]
AB  - AIM: To search for the optimal surgery for gastrinoma and duodenopancreatic 
      neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. 
      METHODS: Sixteen patients with genetically confirmed multiple endocrine neoplasia 
      type 1 (MEN 1) and Zollinger-Ellison syndrome (ZES) underwent resection of both 
      gastrinomas and duodenopancreatic neuroendocrine tumors (NETs) between 1991 and 
      2009. For localization of gastrinoma, selective arterial secretagogue injection 
      test (SASI test) with secretin or calcium solution was performed as well as 
      somatostatin receptor scintigraphy (SRS) and other imaging methods such as 
      computed tomography (CT) or magnetic resonance imaging (MRI). The modus of 
      surgery for gastrinoma has been changed over time, searching for the optimal 
      surgery: pancreaticoduodenectomy (PD) was first performed guided by localization 
      with the SAST test, then local resection of duodenal gastrinomas with dissection 
      of regional lymph nodes (LR), and recently pancreas-preserving total duodenectomy 
      (PPTD) has been performed for multiple duodenal gastrinomas. RESULTS: Among 
      various types of preoperative localizing methods for gastrinoma, the SASI test 
      was the most useful method. Imaging methods such as SRS or CT made it essentially 
      impossible to differentiate functioning gastrinoma among various kinds of NETs. 
      However, recent imaging methods including SRS or CT were useful for detecting 
      both distant metastases and ectopic NETs; therefore they are indispensable for 
      staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients 
      (87.5%); that is, 100% in 3 patients who underwent PD, 100% in 6 patients who 
      underwent LR (although in 2 patients (33.3%) second LR was performed for 
      recurrence of duodenal gastrinoma), and 71.4% in 7 patients who underwent PPTD. 
      Pancreatic NETs more than 1 cm in diameter were resected either by distal 
      pancreatectomy or enucleations, and no hepatic metastases have developed 
      postoperatively. Pathological study of the resected specimens revealed 
      co-existence of pancreatic gastrinoma with duodenal gastrinoma in 2 of 16 
      patients (13%), and G cell hyperplasia and/or microgastrinoma in the duodenal 
      Brunner's gland was revealed in all of 7 duodenal specimens after PPTD. 
      CONCLUSION: Aggressive resection surgery based on accurate localization with the 
      SASI test was useful for biochemical cure of gastrinoma in patients with MEN 1.
FAU - Imamura, Masayuki
AU  - Imamura M
AD  - Department of Surgery, Kansa Electric Power Company Hospital, Osaka, Japan. 
      imamura.masayuki@c4.kepco.co.jp
FAU - Komoto, Izumi
AU  - Komoto I
FAU - Ota, Shuichi
AU  - Ota S
FAU - Hiratsuka, Takuya
AU  - Hiratsuka T
FAU - Kosugi, Shinji
AU  - Kosugi S
FAU - Doi, Ryuichiro
AU  - Doi R
FAU - Awane, Masaaki
AU  - Awane M
FAU - Inoue, Naoya
AU  - Inoue N
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
SB  - IM
MH  - Adult
MH  - Brunner Glands/metabolism
MH  - Female
MH  - Gastrinoma/*diagnosis/pathology/*surgery
MH  - Humans
MH  - Liver Neoplasms/pathology
MH  - Male
MH  - Multiple Endocrine Neoplasia Type 1/*pathology/surgery
MH  - Mutation
MH  - Neoplasm Metastasis
MH  - Neuroendocrine Tumors/pathology
MH  - Pancreatic Neoplasms/pathology
MH  - Pancreaticoduodenectomy/methods
MH  - Tomography, X-Ray Computed/methods
MH  - Treatment Outcome
PMC - PMC3068271
OTO - NOTNLM
OT  - Duodenopancreatic neuroendocrine tumors
OT  - Gastrinoma
OT  - Multiple endocrine neoplasia type 1
OT  - Pancreas-preserving total duodenectomy
OT  - Pancreaticoduodenectomy
OT  - Selective arterial secretagogue injection test
OT  - Somatostatin receptor scintigraphy
EDAT- 2011/04/02 06:00
MHDA- 2011/08/10 06:00
PMCR- 2011/03/14
CRDT- 2011/04/02 06:00
PHST- 2010/08/17 00:00 [received]
PHST- 2010/11/03 00:00 [revised]
PHST- 2010/11/10 00:00 [accepted]
PHST- 2011/04/02 06:00 [entrez]
PHST- 2011/04/02 06:00 [pubmed]
PHST- 2011/08/10 06:00 [medline]
PHST- 2011/03/14 00:00 [pmc-release]
AID - 10.3748/wjg.v17.i10.1343 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2011 Mar 14;17(10):1343-53. doi: 10.3748/wjg.v17.i10.1343.