[Management of gastrinoma]

Area of Science:

• Endocrinology
• Surgical Oncology
• Gastroenterology

Background:

• Gastrinoma is a rare neuroendocrine tumor causing Zollinger-Ellison syndrome (ZES) due to gastrin hypersecretion.
• ZES manifests as severe peptic ulceration and diarrhea, and can be sporadic or part of Multiple Endocrine Neoplasia type 1 (MEN-1).
• Diagnosis relies on detecting hypergastrinemia and hyperchlorhydria, with tumors typically found in the pancreas or duodenum.

Purpose of the Study:

• To outline the diagnostic and therapeutic strategies for gastrinoma.
• To emphasize the role of surgery in managing gastrinoma and improving patient survival.
• To discuss the challenges in preoperative tumor localization and the high rates of recurrence.

Main Methods:

• Review of diagnostic criteria including hypergastrinemia and hyperchlorhydria.
• Discussion of imaging modalities like CT and endoscopic ultrasound for tumor localization.
• Emphasis on surgical resection as the primary curative treatment.

Main Results:

• Surgery offers the only chance for cure, with good long-term survival (median >10 years, 5-year survival >80%) in resected patients.
• Preoperative localization can be challenging due to small and multiple lesions.
• Recurrence rates are high, with biochemical recurrence in 65% and morphological recurrence in 40% of patients within 2 years post-surgery.

Conclusions:

• Surgical resection is crucial for gastrinoma management and cure.
• Effective control of hormonal hypersecretion and tumor removal are key treatment goals.
• Despite good survival, frequent recurrence necessitates vigilant follow-up, while metastases indicate a poor prognosis.