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The gastrinoma triangle: operative implications.

B E Stabile, D J Morrow, E Passaro

    American Journal of Surgery
    |January 1, 1984
    PubMed
    Summary
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    This study identifies a specific surgical area for discovering occult gastrinomas (gastrin-producing tumors). Early excision within this triangle offers potential cure for patients with these rare neuroendocrine tumors.

    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Endocrinology

    Background:

    • Gastrinomas are rare neuroendocrine tumors that cause excess gastrin production.
    • Identifying and surgically removing gastrinomas, especially occult ones, is crucial for patient outcomes.
    • Previous surgical approaches have had variable success in locating and excising all gastrinoma lesions.

    Purpose of the Study:

    • To define a specific anatomical region for improved detection of occult gastrinomas.
    • To evaluate the efficacy of surgical excision for both obvious and occult gastrinomas.
    • To advocate for an aggressive surgical approach in suitable gastrinoma patients.

    Main Methods:

    • Retrospective analysis of 45 patients with gastrinoma undergoing surgical exploration.

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  • Detailed mapping of the anatomical "gastrinoma triangle" where occult tumors were located.
  • Assessment of postoperative gastrin levels and long-term follow-up after tumor excision.

    • Main Results:

    • Of 36 confirmed gastrinomas, 9 (25%) were occult and located within a defined "gastrinoma triangle."
    • Surgical excision of occult tumors, even for diagnosis, resulted in normalized gastrin levels in 3 patients.
    • Two patients with tumors within the triangle achieved apparent cure after excision, with no radical pancreatic resections performed.

    Conclusions:

    • The identified "gastrinoma triangle" is a key area for locating occult gastrinomas.
    • Aggressive surgical excision of gastrinomas, including occult lesions, can lead to apparent cure.
    • An assertive surgical strategy is recommended for eligible gastrinoma patients without liver metastases or MEN1 syndrome.