Surgical management of insulinoma over three decades

HPB (Oxford). 2021 Dec;23(12):1799-1806. doi: 10.1016/j.hpb.2021.04.013. Epub 2021 Apr 27.


Background: This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma.

Methods: A retrospective monocentric cohort study was performed from January 1989 to July 2019, including all the patients who had been operated on for pancreatic insulinoma. The preoperative work-up, surgical management, and postoperative outcome were analyzed.

Results: Eighty patients underwent surgery for sporadic pancreatic insulinoma, 50 of which were female (62%), with a median age of 50 (36-70) years. Preoperatively, the tumors were localized in 76 patients (95%). Computed tomography (CT) and magnetic resonance imaging allowed exact preoperative tumor localization in 76% of the patients (64-85 and 58-88 patients, respectively), increasing to 96% when endoscopic ultrasonography was performed. Forty-one parenchyma-sparing pancreatectomies (PSP) (including enucleation, caudal pancreatectomy, and uncinate process resection) and 39 pancreatic resections were performed. The mortality rate was 6% (n = 5), with a morbidity rate of 72%, including 24 severe complications (30%) and 35 pancreatic fistulas (44%). No differences were found between formal pancreatectomy and PSP in terms of postoperative outcome procedures. The surgery was curative in all the patients.

Conclusion: CT used in combination with endoscopic ultrasonography allows accurate localization of insulinomas in almost all patients. When possible, a parenchyma-sparing pancreatectomy should be proposed as the first-line surgical strategy.

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Insulinoma* / diagnostic imaging
  • Insulinoma* / surgery
  • Middle Aged
  • Pancreatectomy / adverse effects
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / surgery
  • Retrospective Studies
  • Treatment Outcome