Pancreatic insulinomas: experience in 220 patients

To summarize the experience in the diagnosis and treatment of insulinoma.

We retrospectively reviewed 220 patients with insulinoma confirmed surgically in the PUMC Hospital from 1953 to 1999. They were 131 men and 89 women, aged on average 39 years.

In the 220 patients, the average interval from the onset of symptoms to diagnosis was 35 months. 54% of the patients were misdiagnosed before admission to the hospital. In 214 patients underwent operation, 201 (93.9%) had benign tumor and 12 (5.6%) malignant one. The diameter of 78% tumors was less than 2cm. 90.7% tumors were single and 9.3% were multiple. 37.1% tumors were located in the head and uncinate process of the pancreas, 26.1% in the body, 36.1% in the tail, and 0.7% ectopic. 95.5% patients had Whipple's triad and the ratio of insulin to glucose was greater than 0.3 in 89% patients. The positive rates of B-ultrasound, CT and MRI for localization before operation were low, but those of angiography and PTPC were 62.8% and 88% respectively. Most patients could be cured by simple enucleation of tumor. The main complications were pancreatic fistulae and pancreatitis.

It is important for surgeons to familiarize with insulinoma, the most common islet cell tumor, for a better treatment.