Surgical Treatment of Pancreatic Insulinoma: 45 Years of Experience in a Single Center

Abstract

Context Insulinoma is the most common endocrine tumor of the pancreas. Over 90% of insulinomas are benign, single and evenly distributed in head, body and tail of the pancreas. Depending on the location, they can be enucleated or may require partial pancreatectomy. Objective To evaluate histological features, type of surgery, early complications (within 30 days) and prognosis. Methods We reviewed clinical data of patients observed for organic hyperinsulinism from January 1966 to December 2010 in our Department (follow up to December 2011). Results From 1966 to 2010 we observed 102 patients with organic hyperinsulinism (60 females and 42 males averaging 49.5 years). We had 7 cases of hyperplasia/ nesidioblastosis, 7 multiple tumors and 7 malignant insulinomas. Localization: 32 pancreatic head, 8 neck, 21 body, 33 tail, 5 whole pancreas, 1 left ovary and 2 unknown. Surgery: 39 enucleations, 38 distal pancreatectomies, 6 central pancreatectomies, 3 DPPHR, 2 pancreaticoduodenectomies, 4 total/subtotal pancreatectomies, 3 other surgery. Perioperative mortality was 5% (3 acute pancreatitis, 1 stroke, 1 disseminated intravascular coagulation). Perioperative morbidity was 23% (3 acute pancreatitis, 13 pancreatic fistulas, 4 abdominal abscesses, 2 pseudocysts, 1 biliary leakage). In 5 cases a second operation was necessary. Excluding malignant cases, postoperative deaths and not operated cases, 86/88 patients were cured after surgery and we had 2 cases of persistent hypoglycemia (1 hyperplasia, 1 not found). After a mean follow up of 212 months (89 patients included), 64/89 are still alive and free of disease. Among the dead patients, 3/23 died of disease progression. Among 7 malignant cases, 2/7 with lymph node metastases had a survival of 167 and 388 months after resection of the primary tumor and nodes. The median survival of the 5/7 not resected was 12 months. Conclusion Surgical treatment of insulinomas can be challenging and in some cases is still associated to mortality (5%). A high rate of surgical success (98%) was obtained with 5% of reoperation.