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Published in: Surgical Endoscopy 12/2011

01-12-2011

Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases

Authors: Minggen Hu, Guodong Zhao, Ying Luo, Rong Liu

Published in: Surgical Endoscopy | Issue 12/2011

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Abstract

Background

The use of a laparoscopic approach in the treatment of insulinomas is increasing. This retrospective study aimed to evaluate the authors’ experience with laparoscopic surgery for benign pancreatic insulinomas and to compare the results for a laparoscopic approach versus an open approach.

Methods

From January 2000 to December 2009, data were collected retrospectively from 89 patients who underwent resection of pancreatic insulinoma via either laparoscopy (n = 43) or laparotomy (n = 46). Clinical data, tumor features, and intra- and postoperative characteristics were analyzed.

Results

The operation time, blood loss, and complication rate did not differ significantly between the laparoscopic and open approach groups. In the laparoscopic group, the time required to achieve recovery of gastrointestinal function and postoperative oral intake was significantly shorter in the laparotomy group, as was the hospital stay. By the end of the follow-up period, 85 (95.5%) of the 89 patients were symptom free.

Conclusions

Laparoscopic surgery is a safe procedure for patients with benign insulinomas. The complication rates are comparable with those for laparotomy procedures. Relative to open operations, laparoscopic pancreas operations are associated with a more rapid postoperative recovery.
Literature
1.
go back to reference Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S (2007) Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg 24:463–470PubMedCrossRef Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S (2007) Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg 24:463–470PubMedCrossRef
2.
go back to reference Service FJ, McMahon MM, O’Brien PC, Ballard DJ (1991) Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 66:711–719PubMed Service FJ, McMahon MM, O’Brien PC, Ballard DJ (1991) Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 66:711–719PubMed
3.
go back to reference Fendrich V, Waldmann J, Bartsch DK, Langer P (2009) Surgical management of pancreatic endocrine tumors. Nat Rev Clin Oncol 6:419–428PubMedCrossRef Fendrich V, Waldmann J, Bartsch DK, Langer P (2009) Surgical management of pancreatic endocrine tumors. Nat Rev Clin Oncol 6:419–428PubMedCrossRef
4.
go back to reference Sa Cunha A, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21:103–108PubMedCrossRef Sa Cunha A, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21:103–108PubMedCrossRef
6.
go back to reference Bilimoria KY, Tomlinson JS, Merkow RP, Stewart AK, Ko CY, Talamonti MS, Bentrem DJ (2007) Clinicopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9,821 patients. J Gastrointest Surg 11:1460–1467: discussion 1467–1469PubMedCrossRef Bilimoria KY, Tomlinson JS, Merkow RP, Stewart AK, Ko CY, Talamonti MS, Bentrem DJ (2007) Clinicopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9,821 patients. J Gastrointest Surg 11:1460–1467: discussion 1467–1469PubMedCrossRef
7.
go back to reference Finlayson E, Clark OH (2008) Surgical treatment of insulinomas. Surg Clin North Am 84:775–785CrossRef Finlayson E, Clark OH (2008) Surgical treatment of insulinomas. Surg Clin North Am 84:775–785CrossRef
8.
go back to reference Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605PubMedCrossRef Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605PubMedCrossRef
9.
go back to reference Fernandez-Cruz L, Cesar-Borges G (2006) Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg 10:752–760PubMedCrossRef Fernandez-Cruz L, Cesar-Borges G (2006) Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg 10:752–760PubMedCrossRef
10.
go back to reference Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRef Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRef
11.
go back to reference Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128:386–391PubMedCrossRef Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128:386–391PubMedCrossRef
12.
go back to reference Fernandez-Cruz L, Saenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26:1057–1065PubMedCrossRef Fernandez-Cruz L, Saenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26:1057–1065PubMedCrossRef
13.
go back to reference Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18:407–411PubMedCrossRef Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18:407–411PubMedCrossRef
14.
go back to reference Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18:297–302PubMedCrossRef Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18:297–302PubMedCrossRef
15.
go back to reference Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28:1239–1247PubMedCrossRef Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28:1239–1247PubMedCrossRef
16.
go back to reference Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M (2006) Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg 30:1916–1919: discussion 1920–1911PubMedCrossRef Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M (2006) Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg 30:1916–1919: discussion 1920–1911PubMedCrossRef
17.
go back to reference Fendrich V, Langer P (2007) Minimally invasive surgery for pancreatic endocrine tumours. Br J Surg 94:1187–1188PubMedCrossRef Fendrich V, Langer P (2007) Minimally invasive surgery for pancreatic endocrine tumours. Br J Surg 94:1187–1188PubMedCrossRef
18.
go back to reference Kann PH, Rothmund M, Zielke A (2005) Endoscopic ultrasound imaging of insulinomas: limitations and clinical relevance. Exp Clin Endocrinol Diabetes 113:471–474PubMedCrossRef Kann PH, Rothmund M, Zielke A (2005) Endoscopic ultrasound imaging of insulinomas: limitations and clinical relevance. Exp Clin Endocrinol Diabetes 113:471–474PubMedCrossRef
19.
go back to reference Langer P, Bartsch DK, Fendrich V, Kann PH, Rothmund M, Zielke A (2005) Minimal-invasive operative treatment of organic hyperinsulinism. Dtsch Med Wochenschr 130:514–518PubMedCrossRef Langer P, Bartsch DK, Fendrich V, Kann PH, Rothmund M, Zielke A (2005) Minimal-invasive operative treatment of organic hyperinsulinism. Dtsch Med Wochenschr 130:514–518PubMedCrossRef
20.
go back to reference Ayav A, Bresler L, Brunaud L, Boissel P (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390:134–140PubMedCrossRef Ayav A, Bresler L, Brunaud L, Boissel P (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390:134–140PubMedCrossRef
21.
go back to reference Gramatica L Jr, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N (2002) Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 26:1297–1300PubMedCrossRef Gramatica L Jr, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N (2002) Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 26:1297–1300PubMedCrossRef
22.
go back to reference Jaroszewski DE, Schlinkert RT, Thompson GB, Schlinkert DK (2004) Laparoscopic localization and resection of insulinomas. Arch Surg 139:270–274PubMedCrossRef Jaroszewski DE, Schlinkert RT, Thompson GB, Schlinkert DK (2004) Laparoscopic localization and resection of insulinomas. Arch Surg 139:270–274PubMedCrossRef
23.
go back to reference Fernandez-Cruz L, Martinez I, Cesar-Borges G, Astudillo E, Orduna D, Halperin I, Sesmilo G, Puig M (2005) Laparoscopic surgery in patients with sporadic and multiple insulinomas associated with multiple endocrine neoplasia type 1. J Gastrointest Surg 9:381–388PubMedCrossRef Fernandez-Cruz L, Martinez I, Cesar-Borges G, Astudillo E, Orduna D, Halperin I, Sesmilo G, Puig M (2005) Laparoscopic surgery in patients with sporadic and multiple insulinomas associated with multiple endocrine neoplasia type 1. J Gastrointest Surg 9:381–388PubMedCrossRef
24.
go back to reference Minni F, Marrano N, Pasquali R (2003) Laparoscopic body–tail pancreatic resection for insulinoma. Surg Endosc 17:159–160PubMedCrossRef Minni F, Marrano N, Pasquali R (2003) Laparoscopic body–tail pancreatic resection for insulinoma. Surg Endosc 17:159–160PubMedCrossRef
25.
go back to reference Norton JA, Shawker TH, Doppman JL, Miller DL, Fraker DL, Cromack DT, Gorden P, Jensen RT (1990) Localization and surgical treatment of occult insulinomas. Ann Surg 212:615–620PubMedCrossRef Norton JA, Shawker TH, Doppman JL, Miller DL, Fraker DL, Cromack DT, Gorden P, Jensen RT (1990) Localization and surgical treatment of occult insulinomas. Ann Surg 212:615–620PubMedCrossRef
26.
go back to reference Norton JA, Sigel B, Baker AR, Ettinghausen SE, Shawker TH, Krudy AG, Doppman JL, Taylor SI, Gordon P (1985) Localization of an occult insulinoma by intraoperative ultrasonography. Surgery 97:381–384PubMed Norton JA, Sigel B, Baker AR, Ettinghausen SE, Shawker TH, Krudy AG, Doppman JL, Taylor SI, Gordon P (1985) Localization of an occult insulinoma by intraoperative ultrasonography. Surgery 97:381–384PubMed
27.
go back to reference Norton JA (1999) Intraoperative methods to stage and localize pancreatic and duodenal tumors. Ann Oncol 10(Suppl 4):182–184PubMedCrossRef Norton JA (1999) Intraoperative methods to stage and localize pancreatic and duodenal tumors. Ann Oncol 10(Suppl 4):182–184PubMedCrossRef
28.
go back to reference Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A, Chang R, Shawker T, Skarulis MC, Gorden P (2002) Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 194:761–764PubMedCrossRef Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A, Chang R, Shawker T, Skarulis MC, Gorden P (2002) Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 194:761–764PubMedCrossRef
29.
go back to reference Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case–control study. J Am Coll Surg 196:236–242PubMedCrossRef Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case–control study. J Am Coll Surg 196:236–242PubMedCrossRef
30.
go back to reference Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451PubMedCrossRef Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451PubMedCrossRef
31.
go back to reference Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
32.
go back to reference Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef
33.
go back to reference Ramage JK, Davies AH, Ardill J, Bax N, Caplin M, Grossman A, Hawkins R, McNicol AM, Reed N, Sutton R, Thakker R, Aylwin S, Breen D, Britton K, Buchanan K, Corrie P, Gillams A, Lewington V, McCance D, Meeran K, Watkinson A (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 54(Suppl 4):iv1–iv16PubMedCrossRef Ramage JK, Davies AH, Ardill J, Bax N, Caplin M, Grossman A, Hawkins R, McNicol AM, Reed N, Sutton R, Thakker R, Aylwin S, Breen D, Britton K, Buchanan K, Corrie P, Gillams A, Lewington V, McCance D, Meeran K, Watkinson A (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 54(Suppl 4):iv1–iv16PubMedCrossRef
34.
go back to reference Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196PubMedCrossRef Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196PubMedCrossRef
35.
go back to reference Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446PubMed Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446PubMed
36.
go back to reference Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. Surgery 138:8–13 Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. Surgery 138:8–13
Metadata
Title
Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases
Authors
Minggen Hu
Guodong Zhao
Ying Luo
Rong Liu
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 12/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1800-4

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