Management of islet cell carcinoma.

Presentation, treatment, and outcome data were analyzed for 33 patients with islet cell carcinoma who were admitted over a 4 1/2-year period to the surgical service at our institution. The patients were stratified into three groups according to primary mode of therapy as follows: (1) aggressive surgical resection (n = 12); (2) bypass with chemotherapy (n = 13); and (3) diagnostic exploratory laparotomy or bypass without any further therapy (n = 8). Of the patients, 67% were initially seen with advanced disease. Overall, 33% of the tumors were functioning, with a predominance of nonfunctioning tumors in the two groups that were not resectable. Chemotherapy was administered on an individual basis, with symptom palliation as the most common indication. The mean follow-up period was 12.7 +/- 13.1 months (range, 0 to 47.2 months), with an overall estimated 3-year survival rate of 76% calculated by life-table analysis, with 56% alive with disease. The estimated 3-year survival rate was 100% for those who underwent resection, with 83% free of disease. Those patients who had a biopsy or bypass and received chemotherapy had a calculated 3-year survival rate of 34% (p = 0.01 vs. resection), and those who underwent bypass and biopsy only had a 3-year survival rate of 58%. Islet cell carcinoma remains a difficult problem, with primary resection the primary therapeutic modality.