ECE2010 Poster Presentations Endocrine tumours & neoplasia (<emphasis role="italic">Generously supported by Novartis</emphasis>) (82 abstracts)
Surgical treatment of insulinomas: a single-institution experience of 48 patients
Nicolas Carrere 1 , Corneliu Voronca 1 , Delphine Vezzosi 3 , Marie Danjoux 1 , Antoine Bennet 3 , Charles Henri Julio 1 , Eric Bloom 1 , Janick Selves 1 , Rosine Guimbaud 2 , Philippe Otal 2 , Louis Buscail 2 , Bernard Pradére 1 & Philippe Caron 3
1CHU Purpan, Toulouse, France; 2CHU Rangueil, Toulouse, France; 3CHU Larrey, Toulouse, France.
In a monocentric study on 48 patients with insulinomas treated between 1988 and 2008, we evaluate the results of the radiological and surgical procedures, and determine prognostic factors regarding the recurrence risk. Clinical, radiological, and histopathological findings were analysed along with long-term follow-up after surgery. Kaplan–Meier analysis studies recurrence-free survival, and uni- and multi-variable analyses determine prognostic factors related to recurrence risk. The mean age of patients was 51 years (22–78). Echoendoscopy and MRI-scan had a sensitivity of 90 and 85%, respectively. The surgical procedures were duodenopancreatectomy (n=12), left-sided pancreatectomy (n=21), central pancreatectomy (n=5) and enucleation of the tumor (n=7). In three patients (6%) per-operative examination failed to localize a tumor (nesidioblastosis=2, insulinoma=1). On histopathological examination, the insulinomas were benign (n=30), of uncertain behavior (n=11) and well differentiated endocrine carcinomas (n=4). During a median follow-up of 42 months, nine patients experienced a recurrence: three patients with MEN1, four patients with well differentiated endocrine carcinomas, and two patients with a tumor classified as benign who presented liver and regional lymph nodes during follow-up. Only one patient died out of carcinoma progression. In patients with insulinoma totally removed by surgery, the recurrence-free survival rate was 72% after 5 years. A uni-variable analysis revealed that the following factors were predictive of recurrence: histopathological diagnosis of carcinoma (P<0.001), lymph node invasion (P<0.001), expression of Ki67 >1% (P=0.003), and presence of MEN1 mutation. Only endocrine carcinoma and MEN1 disease were identified as significant independent factors of recurrence. In conclusion, in this series of operated patients with insulinoma, the high recurrence rate (28% after 5 years) is mainly related to endocrine carcinomas. This underlines the importance of histopathological criteria for the prognostic evaluation, and of the long-term follow-up after surgical resection, even when the pancreatic endocrine tumor is diagnosed as benign.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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