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Malignant Metastatic Insulinoma—Postoperative Treatment and Follow-up

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Abstract

The rarity of malignant insulinoma limits reports on therapeutic strategies and outcome. The treatment and follow-up of 10 patients, all presenting an insulinoma with metastatic disease of the liver and newly diagnosed between 1992 and 2002, is reported. Pancreatic surgery with successful removal of the primary tumor preferentially located in the tail was performed in 7 women and 3 men, median age 55 years (range 36–82 years). If appropriate, 5 patients underwent additional hepatic surgery and lymph node resections. Liver metastases as the major cause of postoperatively persistent hypoglycemia were subsequently treated by repeated transarterial hepatic chemoembolization and chemoperfusion protocols using high-dose transhepatic streptozocin perfusions (3–4 g per session). The current median survival time for all 10 patients is 2.6 years (range: 1.6–9.7 years). Six patients are currently alive with a median survival of 3.7 years (1.7–9.7 years), five of them with stable disease and free of hypoglycemia. Four patients died after a median survival of 1.8 years (range: 1.6–7.5 years) from complications of unmanageable hypoglycemia. It is concluded that the necessity to treat debiliating and life-threatening hypoglycemia in metastatic malignant insulinoma warrants the option of radical endocrine surgery in combination with extended and repeated postoperative chemoembolization of liver metastases.

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Acknowledgments

Histological details shown in Figure. 2 were provided by Ingo Theuerkauf, M.D., Institute of Pathology, Lukaskrankenhaus, Neuss, Germany, and are gratefully acknowledged.

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Authors and Affiliations

  1. Insulinoma & GEP-Tumor Center, Department of Internal Medicine, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Achim Starke M.D. & Christiane Saddig M.D.

  2. Insulinoma & GEP-Tumor Center, Department of Radiology & Nuclear Medicine, Lukaskrankenhaus, Preussenstrasse 84, 41464, Neuss, Germany

    Lothar Mansfeld M.D. & Rainer Koester M.D.

  3. Insulinoma & GEP-Tumor Center, Department of Pathology, Lukaskrankenhaus, Preussensttasse 84, 41464, Neuss, Germany

    Cyrus Tschahargane M.D.

  4. Insulinoma & GEP-Tumor Center, Department of Internal Medicine, Gastroenterology, & Oncology, Lukaskrankenhaus, Preussenstrasse 84, 41464, Neuss, Germany

    Peter Czygan M.D.

  5. Insulinoma & GEP-Tumor Center, Department of Abdominal & Endocrine Surgery, Lukaskrankenhaus, Preussenstrasse 84, 41464, Neuss, Germany

    Peter Goretzki M.D.

Authors
  1. Achim Starke M.D.
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  2. Christiane Saddig M.D.
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  3. Lothar Mansfeld M.D.
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  4. Rainer Koester M.D.
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  6. Peter Czygan M.D.
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  7. Peter Goretzki M.D.
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Correspondence to Achim Starke M.D..

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Starke, A., Saddig, C., Mansfeld, L. et al. Malignant Metastatic Insulinoma—Postoperative Treatment and Follow-up. World J. Surg. 29, 789–793 (2005). https://doi.org/10.1007/s00268-005-7743-y

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  • DOI: https://doi.org/10.1007/s00268-005-7743-y

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