Surgical management of patients with insulinomas: Result of 292 cases in a single institution.
BACKGROUND
Insulinoma is rare tumor with an incidence of approximately four cases per million per year. There are few large sample, single-center series that focus on the surgical management strategy of insulinomas.


METHODS
Medical records of patients diagnosed as insulinoma from 1990 to 2010 in Peking Union Medical College Hospital were reviewed retrospectively. Clinical data were collected and statistically analyzed.


RESULTS
A total of 328 patients were diagnosed with insulinomas; 292 of them underwent 320 operations, which included 46 laparoscopic surgeries. Tumor enucleation was the most common operative procedure. Multiple tumors were found in 30 cases; 17 cases were multiple endocrine neoplasia-1 syndrome. Thirteen patients with malignant insulinomas underwent tumor resection. Pancreatic fistula (PF) was the most frequent complication, and the incidence of clinical PFs (Grades B and C) was 14.4%. There was no significant statistical difference between open and laparoscopic surgery in blood loss, operative time, and complications. Metachronous tumors were noted in 11 patients.


CONCLUSIONS
Surgery is the best treatment of choice for insulinoma patients. Surgical approach depends on tumor size, location, and its pathological characters. Laparoscopic management of insulinomas is feasible and safe for tumors located in the body or tail of the pancreas. Open surgery combined with intraoperative ultrasonography is recommended to avoid omission of lesions in patients with multiple insulinomas. An aggressive surgical approach is indicated for malignant insulinoma patients.
Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China. zhao8028@263.net
Yu-Pei
YP
Zhao
Han-Xiang
HX
Zhan
Tai-Ping
TP
Zhang
Lin
L
Cong
Meng-Hua
MH
Dai
Quan
Q
Liao
Li-Xing
LX
Cai
D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult