Changes in diagnosis and operative treatment of insulinoma over two decades.

Autor: Wiese D; Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany. wiesed@med.uni-marburg.de., Humburg FG; Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany., Kann PH; Department of Internal Medicine, Center for Endocrinology, Diabetology & Osteology, Philipps University, Marburg, Germany., Rinke A; Division of Gastroenterology and Endocrinology, Department of Internal Medicine, Philipps University, Marburg, Germany., Luster M; Department of Nuclear Medicine, Philipps University, Marburg, Germany., Mahnken A; Department of Diagnostic and Interventional Radiology, Philipps University, Marburg, Germany., Bartsch DK; Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Jun 29; Vol. 408 (1), pp. 255. Date of Electronic Publication: 2023 Jun 29.
DOI: 10.1007/s00423-023-02974-6
Abstrakt: Purpose: Most insulinomas are small solitary, benign neoplasms. Imaging and surgical techniques improved over the last 20 years. Thus, the aim of the present study was to analyze changes in diagnosis and surgery of insulinoma patients in a referral center over two decades.
Methods: Operated patients with a histologically proven insulinoma were retrieved from a prospective database. Clinico-pathological characteristics and outcomes were retrospectively analyzed with regard to the time periods 2000-2010 (group 1) and 2011-2020 (group 2).
Results: Sixty-one of 202 operated patients with pNEN had an insulinoma, 37 (61%) in group 1 and 24 (39%) in group 2. Of those 61 insulinomas, 49 (80%) were sporadic benign, 8 (13%) benign MEN1-associated insulinomas, and 4 (7%) sporadic malignant insulinomas. In 35 of 37 (95%) patients of group 1 and all patients of group 2, the insulinoma was preoperatively identified by imaging. The most sensitive imaging modality was endoscopic ultrasound (EUS) with correctly diagnosed and localized insulinomas in 89% of patients in group 1 and 100% in group 2. In group 1, significantly less patients were operated via minimally invasive approach compared to group 2 (19% (7/37) vs. 50% (12/24), p = 0.022). Enucleation was the most frequently performed operation (31 of 61, 51%), followed by distal resection (15 of 61, 25%) without significant differences between groups 1 and 2. The rate of relevant postoperative complications was not different between groups 1 and 2 (24% vs. 21%, p = 0.99). Two patients with benign insulinoma (1 out of each group) experienced disease recurrence and underwent a second resection. After a median follow-up of 134 (1-249) months, however, all 57 (100%) patients with benign insulinoma and 3 out of 4 patients with malignant insulinoma had no evidence of disease.
Conclusion: Insulinoma can be preoperatively localized in almost all patients, allowing for a minimally invasive, parenchyma-sparing resection in selected patients. The long-term cure rate is excellent.
(© 2023. The Author(s).)
Databáze: MEDLINE
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