INSULINOMA - EXPERIENCE FROM 1950 TO 1995

Insulinomas are rare tumors that originate from the islet cells of the pancreas. The purpose of this study was to analyze our experience in patients with insulinoma and present our approach to these patients. M edical records of 67 patients treated at the University of California, San Francisco (UCSF) Medical Center, 56 surgically and 11 medically, from 1954 to 1995 were retrospectively reviewed. Presenting symptoms, physical findings, laboratory data, pre and intraoperative localizatio n studies, operative management, operative success, and post-operative complications were analyzed. Among the entire cohort, there were 11 p atients with Multiple Endocrine Neoplasia type I (MEN 1) and 7 patient s with multiple tumors. 46 out of 48 patients (96%) having first opera tions for benign tumors and 5 out of 8 patients (63%) having reoperati ons for benign tumors were successful, as were 6 out of 12 patients (5 0%) having operations for islet cell carcinoma. Overall, preoperative localization studies were positive in only 46% of patients and therefo re failed to improve our surgical outcome. Careful palpation with intr aoperative ultrasonography gave the best localization results. Enuclea tion of solitary tumors is curative in sporadic cases and gives the lo west complication rate. In patients with MEN1, subtotal pancreatectomy with enucleation of tumors from the pancreatic head and uncinate proc ess is recommended over simple enucleation because of frequent multipl e tumors.