Highlights
- •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.
Abstract
Background
A single center experience with sporadic pancreatic insulinoma was analyzed to develop
an algorithm for modern surgical management.
Methods
Thirty-four patients undergoing surgery from 2001 to 2019 were reviewed.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: October 21, 2021
Accepted:
October 11,
2021
Received in revised form:
October 9,
2021
Received:
July 2,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
