title: Surgical management of insulinomas: short- and long-term outcomes after enucleations and pancreatic resections.
abstract: OBJECTIVE
  To analyze the characteristics and outcomes following enucleation and pancreatic resections of insulinomas.
  
  
  METHODS
  Retrospective cohort study; prospective database.
  
  
  METHODS
  Academic, tertiary, and referral centers.
  
  
  METHODS
  Consecutive patients with insulinomas (symptoms of hyperinsulinism and positive fasting glucose test) who underwent surgical treatment between January 1990 and December 2009.
  
  
  METHODS
  Operative morbidity, tumor recurrence, and survival after treatment.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Chirurgia Generale B, Policlinico GB Rossi, University of Verona, Piazzale La Scuro, 10-37134, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Letizia
authors.initials: L
authors.lastname: Boninsegna
authors.forename: Vanessa
authors.initials: V
authors.lastname: Capitanio
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
authors.forename: Valerio
authors.initials: V
authors.lastname: Di Carlo
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography