Laparoscopic versus open approach for solitary insulinoma
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In recent years, advances in laparoscopic techniques have allowed surgeons to treat pancreatic lesions laparoscopically. Insulinoma, the most prevalent pancreatic endocrine tumor, is mostly benign and curable with surgical resection. This study aimed to assess the results from laparoscopic resection (LG) of insulinomas and to compare them with the results from open surgery (OG).
From September 1999 to December 2005, 56 laparoscopic pancreatic resections were performed for selected patients, including 12 laparoscopic resections of insulinomas. The results were compared with those of patients who underwent open resection of insulinomas selected from the authors’ pancreatic database.
Three conversions to the open approach were required because of inability to identify the tumor. There were no deaths in either group, and the morbidity rates were 25% (3/12) for LG and 55% (5/9) for OG (nonsignificant difference). The pancreatic fistula rate after laparoscopic enucleation was statistically lower than after open enucleation (14% vs 100%; p = 0.015). The mean postoperative hospital stay was 13 ± 5.9 days for LG and 17.6 ± 7.5 days for OG (nonsignificant difference). After exclusion of the patients who underwent conversion to laparotomy, the mean postoperative hospital stay was 11.5 ± 5.8 days for LG and 17.6 ± 7.5 days for OG (p = 0.04).
This study demonstrates the feasibility and safety of laparoscopic resection of insulinomas. The laparoscopic approach was associated with a decrease in hospital stay and pancreatic fistula after enucleation. Preoperative localization tests and laparoscopic ultrasonography seem necessary to prevent conversion.
KeywordsLaparoscopic enucleation Laparoscopic pancreatic resection Solitary insulinoma
- 27.Lo CY, Lam KY, Kung AW, Lam KS, Tung PH, Fan ST (1997) Pancreatic insulinomas. A 15-year experience. Arch Surg 132(8): 926–30Google Scholar
- 34.Pederzoli P, Bassi C, Falconi M, Camboni MG (1994) Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group. Br J Surg 81(2): 265–9Google Scholar
- 35.Sarr MG (2003) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 196(4): 556–64; discussion 564–5; author reply 565PubMedCrossRefGoogle Scholar
- 36.Shan YS, Sy ED, Lin PW (2003) Role of somatostatin in the prevention of pancreatic stump-related morbidity following elective pancreaticoduodenectomy in high-risk patients and elimination of surgeon-related factors: prospective, randomized, controlled trial. World J Surg 27(6): 709–14PubMedCrossRefGoogle Scholar
- 37.Suc B, Msika S, Piccinini M, Fourtanier G, Hay JM, Flamant Y, et al. (2004) Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg 139(3): 288–94; discussion 295PubMedCrossRefGoogle Scholar
- 38.Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, et al. (2000) Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 232(3): 419–29PubMedCrossRefGoogle Scholar