The role of surgery in patients with Zollinger-Ellison syndrome (ZES) managed medically.

From 1975 to 1981, the authors' deliberate intent was to treat all patients with Zollinger-Ellison syndrome (ZES) medically. This allowed the authors to ask the question of the need for surgical intervention in patients managed medically. Twenty-six patients followed for an average of 37 months (range 2 to 147 months) from diagnosis were maintained on cimetidine for a mean of 32 months (2 to 64 months). Six of these patients (23%) were unable to be maintained on cimetidine and required surgery during this period. Four received total gastrectomy, and two had lesser operations. Analysis of survival curves in this small group does not illustrate a difference between outcome based on surgical or medical management. Prospective studies based on aggressive attempts at preoperative localization with staging laparotomy and tumor resection seem justified.