Kong Weihua, Albers Max Benjamin, Manoharan Jerena, Goebel Joachim Nils, Kann Peter Herbert, Jesinghaus Moritz, Bartsch Detlef Klaus
Department of Surgery, Philipps-University, 35041 Marburg, Germany.
Department of Gastroenterology, Division of Endocrinology and Diabetology, Philipps-University, 35043 Marburg, Germany.
Cancers (Basel). 2022 Apr 11;14(8):1928. doi: 10.3390/cancers14081928.
The aim of this research was to evaluate the long-term outcome of pancreaticoduodenectomy (PD) versus other duodenopancreatic resections (non-PD) for the surgical treatment of the Zollinger-Ellison syndrome (ZES) in patients with multiple endocrine neoplasia type 1 (MEN1).
Prospectively recorded patients with biochemically confirmed MEN1-ZES who underwent duodenopancreatic surgery were retrospectively analyzed in terms of clinical characteristics, complications, cure rate, and long-term morbidity, including quality of life assessment (EORTC QLQ-C30).
35 patients (16 female, 19 male) with MEN1-ZES due to duodenopancreatic gastrinomas with a median age of 42 (range 30-74) years were included. At the time of diagnosis, 28 (80%) gastrinomas were malignant, but distant metastases were only present in one (3%) patient. Eleven patients (31.4%) underwent pancreatoduodenectomy (PD) as the initial procedure, whereas 24 patients underwent non-PD resections involving duodenotomy with gastrinoma excision, enucleation of the pNEN from the head of the pancreas, and peripancreatic lymphadenectomy, either with or without distal pancreatectomy (i.e., either Thompson procedure, = 12, or DUODX, = 12). There was no significant difference in perioperative morbidity and mortality between the two groups ( ≥ 0.05). One (9%) patient of the PD group required reoperation for recurrent or metastatic ZES compared to eight (22.8%) patients of the non-PD resection groups. After a median follow-up time of 134 months (range 6-480) nine of 11 (82%) patients in the PD group, two of 12 (16%) patients in the Thompson procedure group, and three of 12 (25%) patients in the DUODX group had normal serum gastrin levels. In addition, the global health QoLScore was better in the PD group (76.9) compared to the Thompson procedure (57.4) and DUODX (59.5) groups.
Initial PD seems to be the superior surgical procedure for MEN1-ZES, resulting in a long-term cure rate of about 80%, fewer duodenopancreatic reoperations, and an acceptable quality of life.
本研究旨在评估胰十二指肠切除术（PD）与其他十二指肠胰腺切除术（非PD）对1型多发性内分泌腺瘤病（MEN1）患者中卓-艾综合征（ZES）进行手术治疗的长期疗效。
对前瞻性记录的经生化确诊为MEN1-ZES且接受十二指肠胰腺手术的患者，就其临床特征、并发症、治愈率和长期发病率进行回顾性分析，包括生活质量评估（欧洲癌症研究与治疗组织QLQ-C30量表）。
纳入35例因十二指肠胰腺胃泌素瘤导致MEN1-ZES的患者（16例女性，19例男性），中位年龄42岁（范围30 - 74岁）。诊断时，28例（80%）胃泌素瘤为恶性，但仅1例（3%）患者有远处转移。11例患者（31.4%）作为初始手术接受了胰十二指肠切除术（PD），而24例患者接受了非PD切除术，包括十二指肠切开加胃泌素瘤切除术、胰腺头部神经内分泌肿瘤摘除术以及胰周淋巴结清扫术，部分患者还进行了或未进行远端胰腺切除术（即Thompson手术，12例；或DUODX手术，12例）。两组围手术期发病率和死亡率无显著差异（P≥0.05）。PD组有1例（9%）患者因复发性或转移性ZES需要再次手术，而非PD切除组有8例（22.8%）患者。中位随访时间134个月（范围6 - 480个月）后，PD组11例患者中有9例（82%）血清胃泌素水平正常，Thompson手术组12例患者中有2例（16%），DUODX组12例患者中有3例（25%）。此外，PD组的总体健康生活质量评分（76.9）优于Thompson手术组（57.4）和DUODX组（59.5）。
对于MEN1-ZES，初始PD似乎是更优的手术方式，长期治愈率约为80%，十二指肠胰腺再次手术较少，且生活质量可接受。
