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Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma: results of a bi-institutional study.

Abstract：

BACKGROUND:Despite advancements in radiologic imaging and minimally invasive surgery, the evaluation and management of insulinomas is institution and surgeon dependent. Therefore, the reported surgical outcomes are highly variable. We compared the surgical management and outcomes of insulinomas between two international tertiary-care surgical units to better identify the best management as determined by short-term outcomes. METHODS:We performed a retrospective review of patients who underwent surgery for insulinomas over a 117-month period at UT Southwestern Medical Center in Dallas (UTSW) and Queen Mary Hospital in Hong Kong (QMHK). Data collected included imaging studies, operative procedure, complications, and outcomes. RESULTS:Thirty-seven patients were identified. Preoperative localization by computed tomography (CT) scan was successful in 21 patients (63.9%). In Hong Kong, 16 patients underwent selective arterial cannulation and calcium stimulation (SACST) with a success rate of 87.5%. Surgical management consisted of enucleation in 24 patients and distal pancreatectomy in 13 patients. Thirty patients underwent a concurrent intraoperative ultrasound, with localization in 96.7%. Laparoscopic procedures were accomplished in 20 patients. Nine postoperative complications were identified, four occurring in the laparoscopic group. Patients undergoing laparoscopic procedures had a decreased length-of-stay (LOS) compared with patients undergoing an open procedure and patients who had uncomplicated surgery had a trend toward decreased LOS. CONCLUSION:Though the accuracy of CT scans for localizing insulinomas is only 64%, the addition of SACST or intraoperative ultrasound and pancreatic palpation increases accuracy to 97.1%. Compared with open procedures, laparoscopic resection is associated with comparable complication rates and shorter hospital length of stay.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Roland CL,Lo CY,Miller BS,Holt S,Nwariaku FE

doi

10.1245/s10434-008-0157-y

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

3532-7

issue

eissn

1068-9265

issn

1534-4681

journal_volume

pub_type

杂志文章,多中心研究

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Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma: results of a bi-institutional study.