• Annals of surgery · Apr 2018

    Prospective Evaluation of Results of Reoperation in Zollinger-Ellison Syndrome.

    • Jeffrey A Norton, Geoffrey W Krampitz, George A Poultsides, Brendan C Visser, Douglas L Fraker, Alexander H Richard HR University of Maryland, School of Medicine, Baltimore, MD., and Robert T Jensen.
    • Department of Surgery, Stanford University School of Medicine, Stanford, CA.
    • Ann. Surg. 2018 Apr 1; 267 (4): 782-788.

    ObjectiveTo determine the role of reoperation in patients with persistent or recurrent Zollinger-Ellison Syndrome (ZES).BackgroundApproximately, 0% to 60% of ZES patients are disease-free (DF) after an initial operation, but the tumor may recur.MethodsA prospective database was queried.ResultsA total of 223 patients had an initial operation for possible cure of ZES and then were subsequently evaluated serially with cross sectional imaging-computed tomography, magnetic resonance imaging, ultrasound, more recently octreoscan-and functional studies for ZES activity. The mean age at first surgery was 49 years and with an 11-year mean follow-up 52 patients (23%) underwent reoperation when ZES recurred with imageable disease. Results in this group are analyzed in the current report. Reoperation occurred on a mean of 6 years after the initial surgery with a mean number of reoperations of 1 (range 1-5). After reoperation 18/52 patients were initially DF (35%); and after a mean follow-up of 8 years, 13/52 remained DF (25%). During follow-up, 9/52 reoperated patients (17%) died, of whom 7 patients died a disease-related death (13%). The overall survival from first surgery was 84% at 20 years and 68% at 30 years. Multiple endocrine neoplasia type 1 status did not affect survival, but DF interval and liver metastases did.ConclusionsThese results demonstrate that a significant proportion of patients with ZES will develop resectable persistent or recurrent disease after an initial operation. These patients generally have prolonged survival after reoperation and 25% can be cured with repeat surgery, suggesting all ZES patients postresection should have systematic imaging, and if tumor recurs, advise repeat operation.

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