- •Enucleation is the preferred management for sporadic pancreatic insulinoma.
- •Laparoscopic enucleation can be performed safely in select patients.
- •Laparoscopic enucleation can reduce hospital length of stay compared with open.
- •Tumor location and relationship to the pancreatic duct guide management strategy.
A single center experience with sporadic pancreatic insulinoma was analyzed to develop an algorithm for modern surgical management.
Thirty-four patients undergoing surgery from 2001 to 2019 were reviewed.
The majority underwent enucleation (10 laparoscopic, 15 open). Laparoscopy was performed in 22 patients with conversion to open in 11, mostly related to the proximity of the tumor to the pancreatic duct (n = 4). Tumors on the anterior and posterior surface of the pancreas in all anatomic locations were completed with laparoscopic enucleation. Overall, the clinically-relevant postoperative pancreatic fistula (CR-POPF) rate was 21%, with no difference between laparoscopic versus open enucleation (10% vs 20%, p = 0.50) or enucleation versus resection (16% vs 33%, p = 0.27). Laparoscopic enucleation had shorter median hospital length of stay (LOS) compared with open (4 vs 7 days, p = 0.02).
Laparoscopic enucleation does not increase the CR-POPF risk and provides an advantage with a shorter hospital LOS in select patients. Tumor location and relationship to the pancreatic duct guide surgical decision-making. These findings highlight tumor-specific criteria that would benefit from a minimally invasive approach.
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Published online: October 21, 2021
Accepted: October 11, 2021
Received in revised form: October 9, 2021
Received: July 2, 2021
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