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Management of insulinoma, changing trends in developing world
Background
Insulinoma is uncommon endocrine tumors that have a prevalence of around 1 per 100,000 person-years. However; they represent the most common functioning endocrine tumor of the pancreas and is the main cause for hypoglycemia due to endogenous hyperinsulinism. In the presence of significant financial constraints in the patient population pancreatic insulinoma's management is difficult. In last 20 years development in diagnosis and surgery minimize complications.
Methods
We performed an analysis of a clinical series in order to study the clinical and biological spectrum of presentation of Insulinoma, the pre-operatory imagistic diagnosis and results of the surgical approach in a backward and poor infrastructure set up in central India. In 20 years' long period with the development in diagnosis and laparoscopic surgical management simplify management of Insulinoma. Between 2002-2022, 13 patients with symptoms suggesting an insulinoma were hospitalized in our department. All cases except one were presented with neuroglycopenic symptoms and 5 had history of unconsciousness.
Results
Preoperatory localization of insulinomas was possible in 11 patients. Intraoperatory ultrasound was performed in 6 patients. 2 cases managed by laparoscopic surgery. Enucleation was performed in 11 cases while in one case tumor was not palpable during the time of surgery patient underwent blind distal pancreactomy and in one case multiple tumors were present in distal pancreas so distal pancreactomy done. The dimensions of the tumor were more than 2 cm in most of the patients of enucleation group; 1 had multiple insulinomas; In 12 cases patients proved to have benign insulinomas at histological specimens. Following surgery, the symptoms disappear in all patients except one. The most common complication after enucleation was pancreatic fistula seen in two cases.
Conclusions
Presentation of Insulinoma in developing country is delayed due to late diagnosis and most of cases tumor size was more than 2 cm. Patients are younger and have aggressive neuroglycopenic symptoms. Laparoscopic surgical removal of insulinoma is more beneficial due to magnification and minimal invasion.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
