Gastric carcinoid tumours. Is there a place for antrectomy?

Gastric carcinoid tumours are classified in 3 types depending on whether they are sporadic (type 111), or they are associated with a chronic atrophic gastritis (type 1) or a multiple endocrine neoplasia type I-associated Zollinger-Ellison syndrome (type II). For type I tumours, the role of antrectomy, which aims to suppress the causative hypergastrinemia, has not been determined. Aim. - To determine, from literature review the role of antrectomy in the management of type I gastric carcinoid tumours. Methods. - Bibliographic study searching for published observations of antrectomy for type I gastric carcinoid tumours. Data regarding postoperative evolution of gastrinemia and carcinoid tumours were collected. Results. - Thirty-eight published cases were identified. Preoperative gastrinemia was elevated in the 32 patients in whom it was measured. It came to normal ranges in the 19 patients in whom it was postoperatively assessed. With a mean follow-up of 34 months (I to 120), disappearance of carcinoid tumours was observed in 27 of 38 patients (7 1 %), the I I others having tumour recurrence or persistence. When postoperatively assessed, hyperplasia of fundic enterochromaffine-like cells persisted in 7 patients, regressed in 4 and disappeared in the 6 others. No antrectomy-related complication was reported. Conclusion. - Antrectomy can be considered as a worthwile alternative for the treatment of gastric carcinoid tumours related to chronic atrophic ga stritis and hypergastrinemia. (c) 2005 Elsevier SAS. Tons droits reserves.