Norton J A, Sugarbaker P H, Doppman J L, Wesley R A, Maton P N, Gardner J D, Jensen R T
Ann Surg. 1986 Apr;203(4):352-9. doi: 10.1097/00000658-198604000-00003.
Fifteen patients with Zollinger-Ellison syndrome followed at the National Institutes of Health with extensive metastatic disease had an actuarial 5-year survival of 20%. Therefore, in 1982 a prospective study to examine the effect and feasibility of removing all gross tumor in selected patients with extensive metastatic disease was instituted. Five patients with extensive metastatic gastrinoma confined to the abdomen in whom imaging studies suggested the possibility of complete surgical resection were entered into this study and underwent attempted complete surgical resection and chemotherapy with streptozotocin, doxorubicin, and 5-fluorouracil. Median follow-up was 24 months. Surgical resection of all gastrinoma was possible in 4/5 patients attempted. In one patient in whom all gross disease could not be resected, the residual tumor progressed and the patient died 19 months after operation. All four patients with all disease resected appeared to benefit since all of them had a significant reduction in antisecretory medications and are enjoying normal activity and work. Three patients have had no detectable tumor on follow-up, and two of these patients are clinically and biochemically "cured" with normal fasting gastrin levels and negative provocative gastrin tests at 14 and 32 months. Therefore, aggressive resection of metastatic disease in selected patients with malignant gastrinoma is recommended.
在美国国立卫生研究院接受随访的15例患有广泛转移性疾病的卓-艾综合征患者的5年精算生存率为20%。因此，1982年开展了一项前瞻性研究，以检验对部分患有广泛转移性疾病的患者切除所有肉眼可见肿瘤的效果和可行性。5例腹部局限性广泛转移性胃泌素瘤患者，影像学检查提示有可能进行完整手术切除，被纳入本研究，并接受了完整手术切除尝试以及链脲佐菌素、阿霉素和5-氟尿嘧啶化疗。中位随访时间为24个月。在尝试手术的5例患者中，4例成功切除了所有胃泌素瘤。1例患者无法切除所有肉眼可见病灶，残余肿瘤进展，患者术后19个月死亡。所有4例切除所有病灶的患者似乎都从中受益，因为他们所有的抑分泌药物用量都显著减少，并且能够正常活动和工作。3例患者在随访中未检测到肿瘤，其中2例患者在14个月和32个月时临床和生化指标“治愈”，空腹胃泌素水平正常，激发性胃泌素试验阴性。因此，建议对部分恶性胃泌素瘤患者积极切除转移性疾病。
