Document Detail


Achieving eugastrinemia in MEN1 patients: both duodenal inspection and formal lymph node dissection are important.
MedLine Citation:
PMID:  22136834     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Controversy exists regarding the role and extent of operation for patients with multiple endocrine neoplasia type 1 (MEN1) and hypergastrinemia.
METHODS: An institutional MEN1 database was reviewed to identify patients with evidence of hypergastrinemia. The relationship of extent of resection to achievement of eugastrinemia was evaluated.
RESULTS: Operation was performed in 20 patients with MEN1 and hypergastrinemia with a median follow-up of 71 months. Duodenal gastrinomas were identified in 85% of patients who underwent duodenal evaluation. Nodal metastases were identified in 80%. Patients who underwent anatomic regional lymph node dissection (RLND) had a median of 16 nodes removed, vs 1 in patients who did not undergo a formal regional lymphadenectomy. Eugastrinemia was achieved in 12 patients (60%), and 8 (40%) had persistent hypergastrinemia. Compared with patients with persistent hypergastrinemia, patients rendered eugastrinemic more often underwent duodenal evaluation (11/12 vs 2/8; P = .01) and RLND (11/12 vs 3/8; P = .03); there was no relationship between pancreatic resection and achievement of eugastrinemia (P = .32).
CONCLUSION: For patients with MEN1-associated hypergastrinemia selected for operative treatment, a strategy including duodenal evaluation and anatomic regional lymphadenectomy is associated with long-term eugastrinemia. In contrast, the extent of pancreatic resection should be dictated by the extent and distribution of pancreatic neuroendocrine neoplasms, rather than by the presence of hypergastrinemia.
Authors:
Paxton V Dickson; Thereasa A Rich; Yan Xing; Gilbert J Cote; Huamin Wang; Nancy D Perrier; Douglas B Evans; Jeffrey E Lee; Elizabeth G Grubbs
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  150     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-05     Completed Date:  2012-02-06     Revised Date:  2012-06-20    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1143-52     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011. Published by Mosby, Inc.
Affiliation:
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4008, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdomen
Adult
Duodenal Neoplasms / blood,  diagnosis,  surgery*
Female
Gastrinoma / blood,  surgery*
Gastrins / blood*
Humans
Lymph Node Excision*
Male
Middle Aged
Multiple Endocrine Neoplasia Type 1 / blood,  surgery*
Pancreatectomy*
Pancreatic Neoplasms / blood,  surgery*
Pancreaticoduodenectomy
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Gastrins
Comments/Corrections
Comment In:
Chirurg. 2012 May;83(5):480-1   [PMID:  22573248 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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