Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients

Table 1 Results of pancreaticoduodenectomy for patients with multiple endocrine neoplasia type 1

No.	Age	Gender	ZES	Ulcerdiseases	Ulcer related operation	MEN 1 related diseases	Pre-PD IRG (pg/mL)	Localization of gastrinoma			Operation	Post-PD IRG (pg/mL)	Gastrinoma			Metastases		PancreasNET	Prognosis present status(post-op yr)	Postoperative secretin or calcium test
								SASI	GIF	CT			Location	Number	Size (mm)	N	L
1	44	M	+	DU 1984	-	Pit NET 1987	310	GDA IPDA	ND	ND	PitX 1989 Mar	26	D	1	5	1	0	5	Alive well with Pit NET, PNET(18 yr 5 mo)	Negative
											T PitX 1990 Mar
											PD 1991 Mar
2	39	F	+	GU perf 1982	GX 1982	HPT 1991 Nov	800	GDA IPDA	ND	ND	PD, PX 1991 Mar St ParX	33	D	7	1- 7	1	0	6	DOD(4 yr) no recur	Negative
				Ileus 1983	JX 1983
				JU 1990							1991 Nov
3	21	M	+	DU, GU 1997	-	Pit NET 1997	583	GDA	ND	ND	PD 1997 Aug PitX 1997 Oct	25	D	1	10	0	0	0	Alive wll (12 yr) no recur	Negative

ZES: Zollinger-Ellison syndrome; PD: Pancreaticoduodenectomy; SASI: Selective arterial secretagogue injection test; GIF: Gastrointestinal fibroscopy; CT: Computed tomography; IRG: Serum immunoreactive gastrin concentration; N: Lymph node metastasis; L: Liver metastasis; NET: Neuroendocrine tumor; postop: Postoperative; F: Female; M: Male; DU: Duodenal ulcer; GU: Gastric ulcer; JU: Jejunal ulcer; perf: Perforation; GX: Partial gastrectomy; JX: Partial jejunectomy; Pit: Pituitary; PitX: Extirpation of pituitary tumor; T PitX: Total resection of pituitary gland; HPT: Hyperparathyroidism; St ParX: Subtotal parathyroidectomy; GDA: Gastroduodenal artery; IPDA: Inferior pancreatoduodenal artery; ND: Not detected; PX: Partial resection of the pancreas; D: Duodenum; P: Pancreatic; DOD: Died of other disease; Dsmt: Duodenal submucosal tumor; diff: Diffuse; D-EUS: Duodenal endoscopic ultrasonography; no recur: No recurrence.

Table 2 Results of extirpation or partial duodenectomy for duodenal gastrinomas in patients with multiple endocrine neoplasia type 1

No.	Age	Gender	ZES	Ulcer diseases	Ulcer related operation	MEN 1 related diseases	Pre-first duodenectomy IRG (pg/mL)	Localization of gastrinoma			Operation	Post-duodenectomy IRG (pg/mL)	Gastrinoma			Metastases		Pancreas NETs	Prognosis present status (post-op yr)	Postoperativesecretin or calcium test
								SASI	GIF	CT			Location	Number	Size (mm)	N	L
4	49	M	+	GU 1984	GX 1984	HPTPit NET	3,180	GDA	ND	PNET	DX, DP, St ParX 1996 Sep	50	D	9	1-7	0	0	1(gluc)	Alive well, after TParX (2004 Jul) PitX (2006 Oct) (13 yr 10 mo)	Negative
				JU 1995
5	61	F	+	GU 1974	GX 1974	HPT	400	GDA	ND	ND	St Par X 1984 Apr	230 → 140	D	5	2-4	0	0	2	Alive well, (14 yr 4 mo) no recur	Negative
							↓
				JU 1975	JX 1975		230	GDA	ND	ND	DX 1996 Apr
							(post Par X)				DX 2004 Nov	170 → 70	D	1	4	0	0	0
6	56	F	+	DU 1997	-	HPT	580	GDA	ND	ND	PX 1997 Feb	885 → 68	D	3	1-2	1	0	3	Alive well, with mult PNET (9 yr 8 mo)	Negative
							↓				St Par X 1999 Jul
							385 → 885				DX 2001 Jan
							(post Par X)				DX 2007 Jan	400 → 54	D	2	1-3	0	0	0
7	44	F	+	GU 1992	-	PNET					PPPD 1993 Jan	137	-	-	-	0	0	1	Alive well,(9 yr 4 mo) no recur	Negative
						HPT					St Par X 1993 Apr
							811	GDA	Dsmt	ND	DX 2001 Apr	811 → 28	D	1	9	0	0	0
8	33	M	-	- -	-	HPT	3240	GDA	Dsmt	ND	ParX 1993	44	D	1	10	1	0	mult (gluc)	Alive well, (7 yr) No recur	Negative
											St ParX 2003 May
											DX, DP 2003 Jul
9	54	F	+	GU, DU 2005	-	Ins (multi)					DP 1978	149	D	2	6, 12	3	0	1	Alive well, (1 yr 6 mo) no recur	Negative
						HPT	49 500	n n	Dsmt	Dsmt	TParX, TX 1989
						Pit NET			Gsmt	Gsmt	PitX,γ-K 1989, 1995		P(H)	1	15
						GNET				LNMets	DX, GX, LNX 2009 Feb

ZES: Zollinger-Ellison syndrome; SASI: Selective arterial secretagogue injection test; GIF: Gastrointestinal fibroscopy; CT: Computed tomography; IRG: Serum immunoreactive gastrin concentration; N: Lymph node metastasis; L: Liver metastasis; NET: Neuroendocrine tumors; postop: Postoperative; F: Female; M: Male; GU: Gastric ulcer; JU: Jejunal ulcer; DU: Duodenal ulcer; GX: Partial gastrectomy; JX: Partial jejunectomy; HPT: Hyperparathyroidism; P: Pancreatic; Pit: Pituitary; G: Gastric; NET: Neuroendocrine tumor; Ins: Insulinoma; mult: Multiple; ParX: Parathyroidectomy; GDA: Gastroduodenal artery; ND: Not detected; Dsmt: Duodenal submucosal tumor; PX: Partial resection of the pancreas; LN: Lymph node; DX: Extirpation of duodenal gastrinoma and/or partial resection of duodenum; St Parx: Subtotal parthyroidectomy; T Parx: Total parathyroidectomy; TX: Transplantation of parathyroid gland; PPPD: Pylorus preserving pancreaticoduodenectomy; DP: Distal pancreatectomy; D: Duodenum; gluc: Glucagonoma; Mets: Metastasis; P(H): Pancreas head; LNX: Dissection of regional lymph nodes; NN: Not needed; NP: Not performed; no recur: No recurrence.

Table 3 Results of pancreas-preserving total duodenectomy for duodenal gastrinomas in patients with multiple endocrine neoplasia

No.	Age	Gender	ZES	Ulcer diseases	Ulcer related operation	MEN 1 related diseases	Pre-PPTD IRG (pg/mL)	Localization of gastrinoma			Operation		Post-PPTD IRG (pg/ mL)	Gastrinoma			Metastases		Pancreas NETs	Prognosis (post-op yr)	Post-PPTD secretin or calcium test
								SASI	GIF	CT				Location	Number	Size (mm)	N	L
10	51	F	+	DU 1997 Dec	-	HPT	54 800	GDA, IPDA	ND	#6 LN #13 LN	St ParX 2003		216	D	num	1-4	2	0	9 (1; gluc)	Alive well with L Mets (IRG 900) (6 yr 8 mo)	Positive
							↓				Apr
							18 200				PPTD, DP 2003
							(post ParX)				Nov
11	30	M	-	-	-	HPT	820	GDA, IPDA	ND	PNET (uncus tail)	T ParX, TX 2004 Apr		110	D	1	5	0	0	1	Alive well (6 yr) no recur	Negative
							↓
						Pit NET	206				PPTD, DP 2004 Jul
							(post ParX)
12	33	M	+	DU 2004 Mar	-	HPT	3050	GDA, IPDA	Dsmt	ND	T ParX, TX		57	D	1	5	0	0	multi	Alive well (6 yr) no recur	Negative
							↓				2003 Aug
							710				PPTD, DP 2004
							(post ParX)				Aug
13	48	F	-	-	-	HPT	687	IPDA, DPA	Dsmtdiff PNET (D-EUS)	#13LN PNET (< 3 mm) diff	PPTD 2007 Apr		59	D	num	1-5	1	0	multi	Alive well (2 yr 11 mo) no recur	Negative
											T ParX, TX 2007 Sep								diff
14	33	M	+	JU perf 2007 Jan	Patch	HPT	13 900 (post ParX)	GDA	Dsmtdiff PNET (D-EUS)	#17LN Dsmt	T ParX, TX 2001 Dec		255	D	1	8	2	0	multi	Alive well witn N Mets (IRG 371) (2 yr 8 mo)	Positive
											PPTD 2007 Nov								diff
15	57	F	+	DU perf 2006 Jan	GX	HPT	720	GDA, IPDA	ND	ND	T ParX, TX 2007 Mar		42	D	7	2	1	0	0	Alive well (2 yr) no recur	Negative
				JU perf 2006 Jul	JX		↓				PPTD, TG 2008 Aug
				Ileus 2007 May			646
				JU perf 2008 Jul			(post ParX)
16	32	M	+	Es bleeding 2002 Oct		HPT	1630	DGA, SPA	ND	PNET (17 mm)	ParX, PPTD P(T)X	2008 Aug	450	D, P(T)	3, 1	3, 10, 11 10	3	0	3 (> 5 mm)	Alive well (2 mo) no recur	Negative
				DU JU perf 2006 Jan
					JX		1000	DGA, SPA	ND	PNET (5-10 mm)	DP, P(H)X	2009 Jul	94	P(b)	1	4	0	0	multi
				JU perf 2008 Nov	GX, JX

ZES: Zollinger-Ellison syndrome; PPTD: Pancreas preserving total duodenectomy; SASI: Selective arterial secretagogue injection test; op: Operation; GIF: Gastrointestinal fibroscopy; CT: Computed tomography; IRG: Serum immunoreactive gastrin concentration; N: Lymph node metastasis; L: Liver metastasis; NET: Neuroendocrine tumor; F: Female; M: Male; postop: Postoperative; DU: Duodenal ulcer; JU: Jejunal ulcer; perf: Perforation; Es: Esophagus; Patch: Omental patch; GX: Partial gastrectomy; JX: Partial jejunectomy; HPT: Hyperparathyroidism; Pit NET: Pituitary neuroendocrine tumor; ParX: Parathyroidectomy; GDA: Gastroduodenal artery; IPDA: Inferior pancreatoduodenal artery; DPA: Dorsal pancreatic artery; SPA: Splenic artery; ND: Not detected; Dsmt: Duodenal submucosal tumor; diff: Diffuse; D-EUS: Duodenal endoscopic ultrasonography; LN: lymph node; PNET: Pancreatic neuroendocrine tumor; St ParX: Subtotal parathyroidectomy; T ParX: Total parathyroidectomy; TX: Tranplantation of the parathyroid; DP: Distal pancreatectomy; PX: Partial resection of the pancreas; D: Duodenum; P(T): Pancreas tail; num: Numerous; gluc: Glucagonoma; mult: Multiple; NP: Not performed; diff: Diffuse; Met: Metastasis; no recur: No recurrence.