Long-term Outcomes of Surgical Management of Insulinoma: Single Center Experience

Yıl 2018, , 139 - 146, 15.06.2018

Abdullah Ulku Orcun Yalav A. Gokhan Saritas Ahmet Rencuzogullari , Kubilay Dalci İsmail Cem Eray Ozgur Yagmur Atılgan Tolga Akcam

https://doi.org/10.5798/dicletip.424975

Cited By: 1

Öz

Objective:
Limited data are available in regards to the surgical management and outcomes
of insulinoma. This study aimed to assess the outcomes associated with surgical
treatment of insulinoma, as the most common pancreatic endocrine tumor.

Methods:
Medical records of patients who diagnosed as insulinoma from 2000 to 2010 at
General Surgery Department of Cukurova University Hospital were retrospectively
reviewed. Surgical treatment (resection vs. enucleation) was based on
preoperative radiological investigations (abdominal spiral contrast tomography,
ultrasound, selective angiography for selected cases) and intra-operative
ultrasound imaging once indicated.

Results:
Surgically treated thirteen patients (F/M:9/4) who diagnosed with insulinoma
were assessed with a mean follow-up of 5.3 (0.5-10) years. Enucleation and
distal pancreatectomy were performed for 11 and 2 (one of those is
spleen-preserving) patients, respectively. No mortality was recorded. All
patients became normoglycemic after surgery without re-operation and with
acceptable complication rates (n=3 pancreatic fistula, n=1 pancreatitis).

Conclusion:
Surgical treatment of insulinoma is associated with favorable outcomes. Intra-operative
ultrasound with manual palpation is still the gold standard for localizing
insulinoma. Location, size and relationship with main pancreatic duct of the
lesions are key components for the selection of optimal surgical procedure.

Anahtar Kelimeler

insulinoma; surgical treatment; enucleation; pancreatic endocrine tumor.

Kaynakça

• 1. deHerder WW, vanSchaik E, Kwekkeboom D et al. New therapeutic options for metastatic malignant insulinomas. Clin Endocrinol (Oxf). 2011; 75: 277-84.
• 2. Chiruvella A, Kooby DA. Surgical management of pancreatic neuroendocrine tumors. Surg Oncol Clin N Am . 2016; 25: 401–21.
• 3. Krampitz, GW. , Norton JA. Pancreatic neuroendocrine tumors. Curr Probl Surg. 2013; 50:509–45.
• 4. Ellison TA, Edil BH .The current management of pancreatic neuroendocrine tumors. Adv Surg.2012; 46: 283-96.
• 5. Ito T, Igarashi H, Jensen RT.Pancreatic neuroendocrine tumors: clinical features, diagnosis and medical treatment: advances. Best Pract Res Clin Gastroenterol.2012; 26: 737-53.
• 6. Reddy MR, Ramakrishnan S, Kalra P et al. Chronic progressive encephalopathy,intractable seizures, and neuropathy: A triad of neurological features in insulinoma. Neurol India .2012; 60: 238-9.
• 7. Chrysanthi A , Alexander M. N. , Ioannis K. et al.Laparoscopic surgery for pancreatic insulinomas: an updateHormones.2016; 15: 157-69.
• 8. Jensen RT, Cadiot G, Brandi ML et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012; 95: 98-119.
• 9. Tellez-Avila FI, Acosta-Villavicencio GY, Chan C et al. Diagnostic yield of endoscopic ultrasound in patients with hypoglicemia and insulinoma suspected.Endosc Ultrasound.2015; 4: 52-5.
• 10. Puli SR, Kalva N, Bechtold ML et al, Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: a systematic review and metaanalysis. World J Gastroenterol.2013; 19: 3678-84.
• 11. Okabayashi T, Shima Y, Sumiyoshi T et al. Diagnosis and management of insulinoma. World J Gastroenterol.2013; 19: 829-37.
• 12. Guo Q, Wu Y. Surgical treatment of pancreatic islet cell tumor:report of 44 cases. Hepatogastroenterology.2013; 60: 2099-102.
• 13. An L, Li W, Yao KC et al. Assessment of contrast enhanced ultrasonography in diagnosis and preoperative localization of insulinoma. Eur J Radiol.2011;80: 675-80.
• 14. Joseph AJ, Kapoor N, Simon EG et al.Endoscopic ultrasonography-a sensitive tool in the preoperative localization of insulinoma. Endocr Pract.2013; 19: 602-8.
• 15. Mehrabi A, Fischer L, Hafezi M et al. A systematic review of localization, surgical treatment options, and outcome of insulinoma. Pancreas .2014; 43: 675-86.
• 16. Zhang T, Mu Y, Qu L et al.Accurate combined preoperative localization of insulinomas aid the choice for enucleation: a single institution experience over 25years. Hepatogastroenterology. 2012; 59: 1282-5.
• 17. Tamm EP, Bhosale P, Lee JH et al .State of-the-art imaging of pancreatic neuroendocrine tumors. Surg Oncol Clin N Am .2016; 25: 375-400.
• 18. Halfdanarson TR, Rabe KG, Rubin J et al. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Onc .2008; 19: 1727-33.
• 19. Gouya H, Vignaux O, Augui J et al. CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am J Roentgenol. 2003; 181: 987-92.
• 20. Nikfarjam M, Warshaw AL, Axelrod L et al. Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital. Ann Surg .2008; 247: 165-72.
• 21. Thompson SM, Vella A, Thompson GB et al. Selective Arterial Calcium Stimulation With Hepatic Venous Sampling Differentiates Insulinoma From Nesidioblastosis . J Clin Endocrinol Metab. 2015; 100: 4189-97.
• 22. La Rosa S, Pariani D, Calandra C et al. Ectopic duodenal insulinoma: a very rare and challenging tumor type. Description of a case and review of the literature. Endocr Pathol. 2013; 24: 213-9.
• 23. Kulke MH, Anthony LB, Bushnell DL et al . Nanets treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas.Pancreas .2010; 39: 735-752.