Duodenal Wall Tumors and the Zollinger-Ellison Syndrome

Abstract

Surgical management of patients with islet-cell, duodenal wall tumors (DWT), and the Zollinger-Ellison syndrome (ZES) is controversial. Complete tumor excision or total gastrectomy has been advocated. Duodenal wall tumors were identified in 13% (103 of 800) of patients in the Z-E Tumor Registry. The characteristics of ZES patients with DWTs and results of surgery were studied. Less than half of the patients with DWTs had solitary lesions. Four subgroups were identified: group 1, 48 patients with localized DWTs; group 2, 26 patients with DWTs and lymph node metastasis; group 3, 24 patients with duodenal wall and pancreatic tumors; and group 4, five patients with DWTs and islet-cell hyperplasia. Total gastrectomy resulted in the best survival when the DWTs were associated with pancreatic or metastatic lesions or both. Attempts at local tumor excision resulted in a 51% ulcer recurrence rate. Local excision of DWTs with less than total gastrectomy was successful in only 20 patients.