Prospective Evaluation of Results of Reoperation in Zollinger-Ellison Syndrome.
Ann Surg
; 267(4): 782-788, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29517561
ABSTRACT
OBJECTIVE:
To determine the role of reoperation in patients with persistent or recurrent Zollinger-Ellison Syndrome (ZES).BACKGROUND:
Approximately, 0% to 60% of ZES patients are disease-free (DF) after an initial operation, but the tumor may recur.METHODS:
A prospective database was queried.RESULTS:
A 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.CONCLUSIONS:
These 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Reoperação
/
Síndrome de Zollinger-Ellison
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2018
Tipo de documento:
Article