Because of the poor outcome of patients with advanced and metastatic gastrinomas, and the overall disappointing results with systemic therapy, a number of groups have advocated a very aggressive management approach. In 20 patients with locally advanced and metastatic neuroendocrine tumors (10 gastrinomas), aggressive resectional procedures were associated with no operative deaths and a five year actuarial survival of 80%, but most patients will recur [73]. Aggressive liver resection/ablation has also been advocated by the same group [75]. A study of 60 patients with neuroendocrine liver metastases compared patients with medical (“non-aggressive”) treatment, resection/ablation, and chemoembolization +/- resection/ablation. Median survival increased significantly from 20 months to greater than 96 months and 50 months respectively, and 5-year survival from 25% to 72% and 50%, respectively [76]. Those with greater than 50% liver involvement had a poor outcome regardless of approach. A review of 85 patients with liver metastases suggests a more selective approach. Unless a cure with surgical resection is possible, or 90% of tumor volume can be removed, the liver surgery group at Memorial prefers chemoembolization.[77] Bi-lobar disease and patients with greater than 75% liver involvement were least likely to benefit from surgery.

Thus, the literature would suggest that there appears to be some benefit to an aggressive approach in selected patients with advanced and metastatic gastrinoma. However, the selection criteria are unclear, most of the studies are small and non-randomized, and it is a bit difficult to determine if there is a survival benefit.