Insulinomas: clinical features, treatment and outcomes at the National Cancer Institute in Peru

Abstract

Introduction: Insulinomas are rare functional pancreatic tumors with good prognosis when small and benign but dismal results if larger or harbor malignant features. Objective: Analyze clinical features, treatment and clinical outcomes of insulinomas treated in the period 1992 - 2017 at The National Cancer Institute (INEN) of Peru. Methods: All patients with biochemical / histopathological criteria for insulinoma were included and retrospectively analyzed. Results: Fourteen patients were included, [9 women (64.3%); mean age 41.1 ± 17.1 years (range, 11–74)]. Thirteen patients (92.9%) had sporadic tumors. Twelve (85.7%) had solitary tumors. Eleven (78.6%) had fasting hypoglycemia. Mean glucose nadir was 32.4 ± 9.8 mg/dL with a median insulin value of 42 uU/mL (range,14.6–285). The lesion was identified by CT or MRI before surgery in twelve patients. Four (28.6%) were found in the tail and four in the pancreas body. Mean size of lesion 3.75 cm (range; 1.2–14 cm). Nine (64.3%) patients were treated with enucleation and seven of them with laparoscopy (77.8%). No mortality recorded. Two patients had clinically significant pancreatic fistula (ISGPF type B). Three patients (21.4%) had malignant insulinomas, two of them developed metastatic disease after 94 and 156 months and surgery + chemotherapy was offered. Surgery alone achieved curability in twelve (85.7%) patients. Median follow up: 62 months (range; 0-215), overall survival:142 months (range; 60-264). Conclusion: Minimal Invasive surgery became the standard treatment for most patients with insulinoma with high curability rate since 2000. Malignant insulinomas may have favorable long-term outcomes with multimodality treatment.