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Apparent lymph node primary gastrinoma
W S Arnold1, D L Fraker, H R Alexander
1Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
Surgery
|December 1, 1994
Summary
Resection of lymph node (LN) primary gastrinoma is effective for Zollinger-Ellison syndrome (ZES). A significant percentage of patients remain disease-free after surgery, indicating LN gastrinomas warrant surgical consideration.
Area of Science:
- Endocrinology
- Surgical Oncology
- Gastroenterology
Background:
- The origin of gastrinoma, a neuroendocrine tumor, in lymph nodes (LNs) causing Zollinger-Ellison syndrome (ZES) remains debated.
- This study investigates the outcomes of patients with ZES where gastrinomas were exclusively found and removed from LNs.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of surgical resection for primary lymph node gastrinomas in patients with Zollinger-Ellison syndrome.
- To determine if lymph node gastrinomas are a distinct entity and amenable to curative treatment.
Main Methods:
- A retrospective review of 110 patients with ZES who underwent surgical exploration between 1982 and 1992.
- Twenty-one patients (19%) had disease confined to LNs. Surgical exploration involved intraoperative ultrasonography, endoscopy, and duodenotomy.
- Patients were followed annually with biochemical and radiological assessments.
Main Results:
- Of 21 patients with LN-only gastrinomas, 13 (62%) achieved initial biochemical cure.
- Four of these 13 patients experienced biochemical recurrence after a median of 4.2 years.
- Nine patients (43%) remained biochemically cured with no evidence of disease at a median follow-up of 5.3 years.
Conclusions:
- Surgical resection of apparent primary lymph node gastrinomas is a justifiable treatment for Zollinger-Ellison syndrome.
- A substantial proportion of patients (43%) achieved long-term biochemical cure, supporting the concept of LN primary gastrinomas as treatable lesions.