Reoperation may be effective for some patients with Zollinger-Ellison syndrome

Last Updated: 2017-02-16

By Reuters Staff

NEW YORK (Reuters Health) – As many as 25% of patients with persistent or recurrent Zollinger-Ellison syndrome (ZES) can be cured with repeat surgery, a prospective database study suggests.

Few patients with sporadic and multiple endocrine neoplasia type 1 (MEN1) are cured by initial surgery, but the indications for surgical re-exploration, the type of surgery to perform and the benefits of reoperation are largely undefined and controversial.

Dr. Jeffrey A. Norton from Stanford University School of Medicine in California and colleagues queried a prospective database including 223 patients with ZES to determine the role of reoperation in patients with persistent or recurrent ZES.

During a mean follow-up of 11.2 years, 52 patients (23%) developed recurrent or persistent disease and met the criteria for re-exploration, the team reports in Annals of Surgery, online January 17.

The mean time between the initial surgery and the first operation was 7.6 years.

Most patients (n=44) had one reoperation, six had two reoperations, one had three reoperations and another had seven reoperations.

During total follow-up averaging nearly 25 years, nine patients died (17%, seven of them from the disease) a mean of 12 years after the initial operation and five years after the last reoperation.

At the last follow-up after the last reoperation (mean, eight years later), 13 of 52 patients (25%) remained disease-free. All of these patients were sporadic ZES patients; all those with MEN1 recurred.

During follow-up, 21 patients (40%) developed new liver metastases, and the presence of liver metastases was associated with a reduced mean survival of 6.5 years.

“At present, it is not established that reoperation actually increases survival, but the long-term survival with the current approach is excellent,” the researchers conclude. “It is our strategy to reoperate on ZES patients with imaging evidence of recurrent gastrinoma if all identifiable tumors can be completely resected.”

“This has been done with acceptable morbidity and most patients have had excellent survival,” they note. “Patients with either the development of liver metastases or the recurrence of liver metastases (stage 4) disease do worse but some still live for long periods suggesting that this is not a contraindication to this strategy.”

Dr. Norton did not respond to a request for comments.

SOURCE: http://bit.ly/2kW3JAo

Ann Surg 2017.