How to treat gastrinomas in patients with multiple endocrine neoplasia type1: surgery or long-term proton pump inhibitors?

Autor: Imamura M; Neuroendocrine Tumor Center, Kansai Electric Power Hospital, 2-1-7, Fukushima, Fukushima-Ku, Osaka City, 553-0003, Japan. microg606@theia.ocn.ne.jp.; Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyo-Ku, Kyoto City, 606-8507, Japan. microg606@theia.ocn.ne.jp., Komoto I; Department of Surgery, Kansai Electric Power Hospital, 2-1-7, Fukushima, Fukushima-Ku, Osaka City, Japan., Taki Y; Department of Surgery, Kansai Electric Power Hospital, 2-1-7, Fukushima, Fukushima-Ku, Osaka City, Japan.
Jazyk: angličtina
Zdroj: Surgery today [Surg Today] 2023 Dec; Vol. 53 (12), pp. 1325-1334. Date of Electronic Publication: 2022 Dec 07.
DOI: 10.1007/s00595-022-02627-z
Abstrakt: In patients with multiple endocrine neoplasia type 1 syndrome (MEN 1) and Zollinger-Ellison syndrome (ZES), gastrinomas arise from the duodenum, about 60% are multiple, and about 15% of patients have coexisting pancreatic gastrinomas, which can be localized by the selective arterial secretagogue injection test (SASI test). The guidelines (GLs) by the Japanese Neuroendocrine Tumor Society (JNETS) recommend surgical resection for functioning duodenopancreatic neuroendocrine tumors (NETs), including gastrinomas, in patients with MEN1 (Grade A, 100% agreement among members). Conversely, the GLs of the National Comprehensive Cancer Network (NCCN) in the USA recommend observation and treatment with proton pump inhibitors (PPIs) or exploratory surgery for occult gastrinomas. An international Consensus Statement (ICS) from the European Union (EU) also does not recommend resection of gastrinomas in patients with MEN1, despite some surgeons having reported surgery being curative for gastrinomas in MEN1 patients. In this review, we discuss the serious side effects and tumorigenic effects of the prolonged use of PPIs and the safety and curability of surgery, supported by our results of curative surgery for gastrinomas in 20 patients with MEN1 over 30 years. We conclude that surgery should be the first-line treatment for gastrinomas in MEN1 patients.
(© 2022. The Author(s).)
Databáze: MEDLINE
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