Pancreatic Insulinoma: A Surgical Experience

• Published in: World journal of surgery Vol. 33; no. 9; pp. 1966 - 1970
• Main Authors: España-Gómez, María Nayví, Velázquez-Fernández, David, Bezaury, Paulina, Sierra, Mauricio, Pantoja, Juan Pablo, Herrera, Miguel F.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2009; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Biological and medical sciences; Cardiac Surgery; Chi-Square Distribution; Diagnostic Imaging; Distal Pancreatectomy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Fibrin Glue; General aspects; General Surgery; Humans; Insulinoma - diagnosis; Insulinoma - pathology; Insulinoma - surgery; Insulinomas; Laparoscopic Resection; Laparoscopy - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Pancreatic Fistula; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Postoperative Complications; Surgery; Thoracic Surgery; Tumors. Hypoglycemia; Vascular Surgery; Distal Pancreatectomy; Pancreatic Fistula; Fibrin Glue; Insulinomas; Laparoscopic Resection; Endocrinopathy; Secretory tumor; Medicine; Treatment; Surgery; Insulinoma; Digestive diseases; Benign neoplasm; Endocrine pancreatic diseases; Pancreas; Pancreatic disease
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0145-9

Background Small size, high benignity rate, and sporadic nature make insulinomas suitable for laparoscopic resection. On the other hand, occult location or multicentricity mandate open surgery. This study was designed to analyze a series of patients who had pancreatic insulinomas and underwent initial treatment at our institution. Methods Clinical records of the 34 patients with pancreatic insulinomas who underwent surgical resection between 1995 and 2007 were reviewed. Main variables for analysis were cure of the disease and surgical complications. Results There were 20 women and 14 men with a mean age of 40 ± 13 years. Mean size of the tumors was 2.2 ± 1 cm. Laparoscopic resection was completed in 14 of 21 patients. Most tumors that were resected by laparoscopy were solitary, benign, and located in the body and tail of the pancreas. Open surgery was selected for 13 patients, including 7 sporadic (5 in the head), 4 related to the MEN syndrome, and 2 malignant tumors. Surgical morbidity occurred in 23 patients. The most common complication was pancreatic fistula (3/13 in open, 4/14 in laparoscopic, and 6/7 in conversions). One patient in the open group died 15 days after surgery from massive PTE. Postoperative normoglycemia was achieved in all patients and persisted for a follow-up period of 4 ± 3.7 years. Conclusions Most insulinomas in our series were small and benign. Tumors that were located in the body and tail were more often amenable for laparoscopic resection. The cure rate was very high. Pancreatic fistula was the most frequent complication.