PMID- 18156937
OWN - NLM
STAT- MEDLINE
DCOM- 20080221
LR  - 20220330
IS  - 0003-4932 (Print)
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 247
IP  - 1
DP  - 2008 Jan
TI  - Improved contemporary surgical management of insulinomas: a 25-year experience at 
      the Massachusetts General Hospital.
PG  - 165-72
AB  - OBJECTIVE: To determine changes in the management strategy of patients with 
      insulinomas and identify critical factors in patient outcome. BACKGROUND: 
      Pancreatic insulinomas are rare neoplasms that are present in various ways. The 
      optimal approach to localization, operative management, and follow-up of 
      insulinomas is undetermined. METHODS: Sixty-one patients with a diagnosis of 
      insulinoma requiring surgery at a tertiary care center between 1983 and 2007 were 
      reviewed. Demographic details, mode of presentation, preoperative localization, 
      operative procedures, and pathology data were assessed. The effect of different 
      factors on survival was determined. RESULTS: Seven of 61 (11%) patients had a 
      diagnosis of multiple endocrine neoplasia-type 1 (MEN-1). Multiple insulinomas 
      were noted in 8% of cases and were more common in MEN-1 patients. The overall 
      rate of malignancy was 8%. Confusion (67%), visual disturbances (42%), and 
      diaphoresis (30%) were the most common presenting symptoms. Weight gain was noted 
      in 44% of patients. The median duration of symptoms before diagnosis was 18 
      (1-240) months. The sensitivity of preoperative imaging of tumors before 1994 was 
      75%, compared with 98% after this period, which included use of endoscopic 
      ultrasound scanning (P = 0.012). A combination of palpation and intraoperative 
      ultrasound detected 92% of tumors. Distal pancreatectomy (40%), enucleation 
      (34%), and pancreaticoduodenectomy (16%) were the most common procedures and 
      pancreatic fistula occurred in 18% of patients. Three patients underwent 
      noncurative distal pancreatectomy in the early period. The 10-year 
      disease-specific and disease-free survival was 100% and 90% respectively. There 
      were 5 patients with disease recurrence. Lymph node metastases (P < 0.001), 
      lymphovascular invasion (P < 0.001), and the presence of MEN-1 (P = 0.035) were 
      prognostically significant adverse factors in disease-free survival. 
      Lymphovascular invasion was the only significant factor on multivariate analysis 
      (P = 0.002). CONCLUSION: Pancreatic insulinomas can be readily localized 
      preoperatively with modern imaging to avoid unsuccessful blind pancreatic 
      resection. Surgical resection is associated with low morbidity and mortality and 
      achieves long-term disease-free survival in the absence of lymphovascular 
      invasion.
FAU - Nikfarjam, Mehrdad
AU  - Nikfarjam M
AD  - Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 
      Fruit Street, Boston, MA 02114, USA.
FAU - Warshaw, Andrew L
AU  - Warshaw AL
FAU - Axelrod, Lloyd
AU  - Axelrod L
FAU - Deshpande, Vikram
AU  - Deshpande V
FAU - Thayer, Sarah P
AU  - Thayer SP
FAU - Ferrone, Cristina R
AU  - Ferrone CR
FAU - Fernandez-del Castillo, Carlos
AU  - Fernandez-del Castillo C
LA  - eng
GR  - P01 CA117969/CA/NCI NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Chi-Square Distribution
MH  - Child
MH  - Female
MH  - Humans
MH  - Insulinoma/epidemiology/*surgery
MH  - Male
MH  - Massachusetts/epidemiology
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/epidemiology
MH  - Pancreatic Neoplasms/epidemiology/*surgery
MH  - Postoperative Complications/epidemiology
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Statistics, Nonparametric
MH  - Survival Rate
MH  - Treatment Outcome
PMC - PMC3806046
MID - NIHMS517363
EDAT- 2007/12/25 09:00
MHDA- 2008/02/22 09:00
PMCR- 2013/10/23
CRDT- 2007/12/25 09:00
PHST- 2007/12/25 09:00 [pubmed]
PHST- 2008/02/22 09:00 [medline]
PHST- 2007/12/25 09:00 [entrez]
PHST- 2013/10/23 00:00 [pmc-release]
AID - 00000658-200801000-00024 [pii]
AID - 10.1097/SLA.0b013e31815792ed [doi]
PST - ppublish
SO  - Ann Surg. 2008 Jan;247(1):165-72. doi: 10.1097/SLA.0b013e31815792ed.