Pancreatic insulinomas. A 15-year experience

Arch Surg. 1997 Aug;132(8):926-30. doi: 10.1001/archsurg.1997.01430320128023.

Abstract

Objective: To describe our experience in the management of patients with pancreatic insulinomas, emphasizing the need for preoperative localization and the outcome of surgical treatment.

Design: A case series.

Setting: A university hospital in Hong Kong.

Patients: From 1981 to 1995, 27 patients with pancreatic insulinomas were surgically treated; the mean follow-up was 25.4 months.

Main outcome measures: Postoperative morbidity and euglycemia during the follow-up period.

Results: The accuracy of tumor localization by ultrasonography, computed tomography, and angiography was 33%, 44%, and 52%, respectively. Venous sampling for an insulin assay regionalized 90% of the tumors. In 24 patients with solitary tumors, most lesions detected or missed by preoperative localization could be either seen (n = 14) or palpated (n = 22). Intraoperative ultrasonography (n = 17) has been routinely performed since 1987; nonpalpable tumors were imaged in 2 of 15 patients with solitary tumors. Eight solitary occult tumors were detected by palpation alone or a combination of palpation and intraoperative ultrasonography. Operative mortality occurred in 1 (3.7%) of the 27 patients, while major morbidity developed in 9 (33%) of the patients. Euglycemia was achieved in 25 patients. Surgery cured all patients with benign insulinomas, whereas the cure rate for patients with malignant neoplasms was only 33%. The type of surgical treatment or correct preoperative localization did not affect the outcome of surgery.

Conclusions: Pancreatic insulinomas can be readily localized intraoperatively despite failed preoperative localization studies. Surgical treatment cured benign adenomas but was associated with notable morbidity.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Insulinoma / pathology
  • Insulinoma / surgery*
  • Intraoperative Period
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / epidemiology
  • Preoperative Care