Endocrine Abstracts (2013) 32 P530 | DOI: 10.1530/endoabs.32.P530

Insulinoma: is enucleation a safe option?

Anneke Jilesen, Heinz-Josef Klumpen, Peter Bisschop, Olivier Busch, Thomas van Gulik, Dirk Gouma & Els Nieveen van Dijkum

AMC, Amsterdam, The Netherlands.

Background: Insulinomas are the most prevalent functional neuroendocrine tumors of the pancreas. Enucleation is often preferred to pancreatic resection because it’s minimally invasive nature. The aim of this study is to assess the post-operative surgical outcome in particular pancreatic fistula after resection.

Methods: All patients with insulinomas were selected from a retrospective database of resected pancreatic neuroendocrine tumors (pNET). Patients were operated between 1992 and 2012. Surgical procedure and post-operative outcome were analysed.

Results: A total of 109 patients with pNET underwent resection, 22 patients had an insulinomas (20%), 12 women and ten men with a median age of 50 years (21–83 years). Three patients had MEN-1 syndrome (14%). Somatostatin receptor scintigraphy was performed in 12/22 patients and showed accumulation of the radiopharmacon in the insulinomas in two patients. Twelve patients underwent enucleation of the insulinoma, n=8 located in the head, n=2 in the tail, n=2 in the central/tail region. All enucleated insulinomas were smaller than 20 mm. Ten patients underwent pancreatic resection, n=6 tail resection, n=3 corpus/tail resection, n=1 head/corpus resection including pancreatic jejunostomy. Complications occurred in 7/12 (58%) enucleation patients and in 4/10 (40%) patients with a pancreatic resection (P=0.4). The most frequent complication was pancreatic leakage in 9/22 (41%), respectively 7/12 for enucleation and 2/10 for pancreatic resection (P=0.1). Two patients developed diabetes mellitus post-operatively; both patients were diagnosed with recurrent insulinoma and underwent multiple pancreatic resections. One MEN-1 patient developed metastatic disease of the insulinomas after resection of the primary.

Conclusions: Enucleation can be frequently performed in 55% for insulinomas and it’s a less invasive operation technique without endocrine insufficiency but with a high complication rate, especially for pancreatic fistula. Although insulinomas are usually small, a pancreatic resection is a safe alternative option. Careful patient selection and operation should be performed.

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