MEN1/ZES patients have, in the vast majority, multiple, frequently small gastrinomas in the duodenum associated with >50% having lymph node metastases, resulting in them having a very low surgical cure rate (<0–<5%) with the standard surgical operations that are currently recommended; however, they do not include aggressive surgical resections such as a Whipple procedure [18,28,54,55,56,57,58], which is not routinely recommended because of its increased morbidity [28,58]. This evidence concerns the gene MEN1 and metastatic malignant neoplasm in the lymph nodes.