Minimally invasive surgery for pancreatic endocrine tumours

Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases

BACKGROUND

The use of a laparoscopic approach in the treatment of insulinomas is increasing. This retrospective study aimed to evaluate the authors' experience with laparoscopic surgery for benign pancreatic insulinomas and to compare the results for a laparoscopic approach versus an open approach.

METHODS

From January 2000 to December 2009, data were collected retrospectively from 89 patients who underwent resection of pancreatic insulinoma via either laparoscopy (n = 43) or laparotomy (n = 46). Clinical data, tumor features, and intra- and postoperative characteristics were analyzed.

RESULTS

The operation time, blood loss, and complication rate did not differ significantly between the laparoscopic and open approach groups. In the laparoscopic group, the time required to achieve recovery of gastrointestinal function and postoperative oral intake was significantly shorter in the laparotomy group, as was the hospital stay. By the end of the follow-up period, 85 (95.5%) of the 89 patients were symptom free.

CONCLUSIONS

Laparoscopic surgery is a safe procedure for patients with benign insulinomas. The complication rates are comparable with those for laparotomy procedures. Relative to open operations, laparoscopic pancreas operations are associated with a more rapid postoperative recovery.

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.

PATIENTS AND 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.

CONCLUSION

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.

Laparoscopic surgery for pancreatic insulinomas: a single-institution experience of 29 cases

BACKGROUND

Laparoscopic approach has been increasingly used in the treatment of pancreatic benign diseases. This report evaluates our experience with laparoscopic surgery for pancreatic insulinomas.

METHODS

Between July 2000 and December 2007, laparoscopic pancreatectomy was attempted in 29 consecutive patients with insulinomas. The localization of tumors, operating characteristics, and clinical outcomes were analyzed.

RESULTS

Tumors were precisely localized in 28 of 29 (96.6%) patients by a combination of preoperative imaging techniques and intraoperative ultrasonography. Laparoscopic pancreatectomy was successfully performed in 26 patients, including enucleation (n = 14), hand-assisted enucleation (n = 2), and distal pancreatectomy with (n = 9) or without (n = 1) spleen preservation. Two conversions to open procedure were required because of unfavorable locations of the tumors. The pancreatic fistula occurred in four patients who underwent tumor enucleation. The median hospital stay was 5.5 days (range, 3-18 days) after laparoscopic procedure. Twenty-eight patients with pancreatic resection were free of symptoms and remained normoglycemic after a median follow-up period of 19 months (range, 10-36 months).

CONCLUSION

Laparoscopic pancreatic resection is a feasible and safe procedure for patients with insulinomas. Further studies are required to evaluate the potential application of the hand-assisted approach for tumors located at anatomically unfavorable positions.