Insulinoma of Pancreas, Brief Experience at a Dedicated Surgical Oncology Department

Abstract

Introduction: Insulinoma of pancreas is a rare neuroendocrine tumor (NET). Mostly insulinomas are benign and solitary. They can have association with multiple endocrine neoplasia 1 (MEN -1). Insulinomas presents with symptoms of hypoglycemia. Most of the times the symptoms are vague and result in delay in the diagnosis and hence management. After appropriate diagnostic and localization investigations along with metastatic workup, surgery is the treatment of choice. Surgery can offer cure. Minimally invasive surgery can offer potential benefits of minimal morbidity and at least equal oncological outcomes. Study Design: Case series. Place and Duration of Study: Department of Surgical Oncology, Shaukat Khanam Memorial Cancer Hospital & Research Center (SKMCH&RC), from January 2011 to March 2020. Methodology: We studied a total of five patients that presented to SKMCH&RC in the above-mentioned period. Detailed clinical information of these five patients, including sociodemographic variables, symptomatology, diagnostic and localization investigations, clinical and pathological staging, comprehensive details of surgery, postoperative course, oncological outcomes, postoperative resolution of symptoms, postoperative diabetes, prognosis and follow up duration were analysed. The record was being retrospectively retrieved from Hospital Information System (HIS) that is prospectively maintained. We are a paperless hospital and all data and record of the patient is maintained through HIS. Results: A total of five patients presented to SKMCH&RC with a mean age of 41 (18 -80) years. The median duration of symptoms was 24 (6-60) months. Symptomatic hypoglycemia was present in all 5 (100%) of the patients. Tumor distribution in the pancreas was as follows; uncinate 1 (20%), body 1 (20%) and tail 3 (60%). All five patients (100%) were treated by surgery. Resolution of symptoms occurred in all five (100%) of the patients. Conclusion: Insulinoma of pancreas is a rare disease with varied symptomatology, physicians shall have an index of suspicion for this disorder to aid early diagnosis that is pivotal for the management and prevention of possible fatal complications of hypoglycemia. Appropriate diagnostic and localizing investigations are required. Adequate surgery can offer cure. Minimally invasive surgery can be safely offered with equal oncological outcomes.