Related Experiment Videos
Aggressive resection of metastatic disease in selected patients with malignant gastrinoma
Abstract:
Fifteen patients with Zollinger-Ellison syndrome followed at the National Institutes of Health with extensive metastatic disease had an actuarial 5-year survival of 20%. Therefore, in 1982 a prospective study to examine the effect and feasibility of removing all gross tumor in selected patients with extensive metastatic disease was instituted. Five patients with extensive metastatic gastrinoma confined to the abdomen in whom imaging studies suggested the possibility of complete surgical resection were entered into this study and underwent attempted complete surgical resection and chemotherapy with streptozotocin, doxorubicin, and 5-fluorouracil. Median follow-up was 24 months. Surgical resection of all gastrinoma was possible in 4/5 patients attempted. In one patient in whom all gross disease could not be resected, the residual tumor progressed and the patient died 19 months after operation. All four patients with all disease resected appeared to benefit since all of them had a significant reduction in antisecretory medications and are enjoying normal activity and work. Three patients have had no detectable tumor on follow-up, and two of these patients are clinically and biochemically "cured" with normal fasting gastrin levels and negative provocative gastrin tests at 14 and 32 months. Therefore, aggressive resection of metastatic disease in selected patients with malignant gastrinoma is recommended.
Insights
Aggressive surgical resection of metastatic gastrinoma (Zollinger-Ellison syndrome) in selected patients significantly improves survival and quality of life. Complete tumor removal leads to reduced medication needs and potential long-term remission.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Zollinger-Ellison syndrome (gastrinoma) with extensive metastatic disease has a poor prognosis, with a 5-year survival rate of 20% in previously studied patients.
- Metastatic gastrinoma presents significant challenges in management due to its aggressive nature and potential for widespread dissemination.
Purpose of the Study:
- To evaluate the feasibility and efficacy of complete surgical resection of gross tumor in patients with extensive metastatic gastrinoma.
- To assess the impact of aggressive surgical debulking combined with chemotherapy on patient survival and clinical outcomes.
Main Methods:
- A prospective study was initiated in 1982 involving selected patients with extensive metastatic gastrinoma confined to the abdomen.
- Five patients underwent attempted complete surgical resection followed by chemotherapy with streptozotocin, doxorubicin, and 5-fluorouracil.
- Follow-up included clinical assessment, biochemical testing (fasting gastrin, provocative gastrin tests), and tumor surveillance.
Main Results:
- Complete surgical resection of all gross gastrinoma was achieved in 4 out of 5 attempted patients.
- Patients with complete resection showed significant reductions in antisecretory medication requirements and improved quality of life.
- Three patients achieved no detectable tumor on follow-up, with two experiencing clinical and biochemical remission at 14 and 32 months.
- The single patient with incomplete resection experienced tumor progression and died 19 months post-operation.
Conclusions:
- Aggressive surgical resection of metastatic gastrinoma is a feasible and beneficial approach in carefully selected patients.
- Complete tumor removal can lead to long-term disease control, improved patient survival, and biochemical cure.
- This strategy offers a potential survival benefit for patients with advanced malignant gastrinoma.