Article

Surgical Management of Insulinomas Short- and Long-term Outcomes After Enucleations and Pancreatic Resections

Department of Surgery, Chirurgia Generale B, Policlinico GB Rossi, University of Verona, Piazzale La Scuro, 10-37134, Verona, Italy.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.3). 03/2012; 147(3):261-6. DOI: 10.1001/archsurg.2011.1843
Source: PubMed

ABSTRACT To analyze the characteristics and outcomes following enucleation and pancreatic resections of insulinomas.
Retrospective cohort study; prospective database.
Academic, tertiary, and referral centers.
Consecutive patients with insulinomas (symptoms of hyperinsulinism and positive fasting glucose test) who underwent surgical treatment between January 1990 and December 2009.
Operative morbidity, tumor recurrence, and survival after treatment.
A total of 198 patients (58.5% women; median age, 48 years) were identified. There were 175 (88%) neuroendocrine tumors grade G1 and 23 (12%) neuroendocrine tumors grade G2. Malignant insulinomas defined by lymph node/liver metastases were found in 7 patients (3.5%). Multiple insulinomas were found in 8% of patients, and 5.5% of patients had multiple endocrine neoplasia type 1. Surgical procedures included 106 enucleations (54%) and 92 pancreatic resections (46%). Mortality was nil. Rate of clinically significant pancreatic fistula was 18%. Enucleations had a higher reoperation rate compared with pancreatic resections (8.5% vs 1%; P = .02). Multiple endocrine neoplasia type 1 was significantly associated with younger age at onset (P < .005) and higher rates of malignancies and multiple lesions. Median follow-up was 65 months. Six patients (3%; 5 patients had neuroendocrine tumors grade G2) developed tumor recurrence. Four patients (2%) died of disease. New exocrine (1.5%) and endocrine (4%) insufficiencies were associated only with pancreatic resections.
Outcomes following surgical resection of insulinomas are satisfactory, with no mortality and good functional results. Recurrence is uncommon (3%), and it is more likely associated with neuroendocrine tumors grade G2. Insulinomas in multiple endocrine neoplasia type 1 are at higher risk for being malignant and multifocal, requiring pancreatic resections.

Download full-text

Full-text

Available from: Stefano Crippa, Jul 04, 2015
0 Followers
 · 
196 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.
    The Scientific World Journal 12/2012; 2012:357475. DOI:10.1100/2012/357475 · 1.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neuroendocrine tumors (NET) are usually slow-growing neoplasms carrying an overall favorable prognosis. Surgery, from resection to transplantation, remains the only potential curative option for these patients, and should always be considered. Nevertheless, because of very few randomized controlled trials available, the optimal treatment for these patients remains controversial, especially regarding the place of surgery. We herein discuss the place of surgical resection in the treatment strategy in neuroendocrine tumors of the digestive tract.
    Targeted Oncology 08/2012; 7(3):153-9. DOI:10.1007/s11523-012-0230-0 · 3.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE OF REVIEW: Neuroendocrine tumors of the gastrointestinal tract are rare tumors, but as they have become recognized more often, and their care has been concentrated at some centers, standards of care have developed. With these standards, questions in the field have led to focused studies to inform practitioners. RECENT FINDINGS: The efficacy and morbidity of care have been well delineated now for pancreatic neuroendocrine tumors, as well as the effect of stretching the bounds of resection to include vascular reconstruction. The management of the gallbladder in patients with mid-gut carcinoid tumors and palliative approaches to mesenteric vein compression have been reported. The operative management of liver metastases shows the benefit of this approach, even when incomplete, as well as the safety of performing complex procedures in appropriate situations. SUMMARY: Some of the difficult or controversial decision areas in the surgical care of patients with neuroendocrine tumors are now more clear because of recently reported data.
    Current opinion in endocrinology, diabetes, and obesity 11/2012; DOI:10.1097/MED.0b013e32835b7efa · 3.77 Impact Factor