Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
Am J Surg. 2022 May;223(5):912-917. doi: 10.1016/j.amjsurg.2021.10.011. Epub 2021 Oct 22.
A single center experience with sporadic pancreatic insulinoma was analyzed to develop an algorithm for modern surgical management.
Thirty-four patients undergoing surgery from 2001 to 2019 were reviewed.
The majority underwent enucleation (10 laparoscopic, 15 open). Laparoscopy was performed in 22 patients with conversion to open in 11, mostly related to the proximity of the tumor to the pancreatic duct (n = 4). Tumors on the anterior and posterior surface of the pancreas in all anatomic locations were completed with laparoscopic enucleation. Overall, the clinically-relevant postoperative pancreatic fistula (CR-POPF) rate was 21%, with no difference between laparoscopic versus open enucleation (10% vs 20%, p = 0.50) or enucleation versus resection (16% vs 33%, p = 0.27). Laparoscopic enucleation had shorter median hospital length of stay (LOS) compared with open (4 vs 7 days, p = 0.02).
Laparoscopic enucleation does not increase the CR-POPF risk and provides an advantage with a shorter hospital LOS in select patients. Tumor location and relationship to the pancreatic duct guide surgical decision-making. These findings highlight tumor-specific criteria that would benefit from a minimally invasive approach.
分析单个中心散发胰岛素瘤的经验，以制定现代外科治疗的算法。
回顾了 2001 年至 2019 年期间接受手术的 34 例患者的资料。
大多数患者接受了肿瘤剜除术（10 例腹腔镜，15 例开腹）。22 例患者行腹腔镜手术，其中 11 例转为开腹，主要与肿瘤靠近胰管有关（n=4）。所有解剖位置胰腺前、后表面的肿瘤均通过腹腔镜肿瘤剜除术完成。总体而言，术后临床相关胰瘘（CR-POPF）发生率为 21%，腹腔镜与开腹肿瘤剜除术（10%比 20%，p=0.50）或肿瘤剜除术与切除术（16%比 33%，p=0.27）之间无差异。腹腔镜肿瘤剜除术的中位住院时间（LOS）短于开腹手术（4 天比 7 天，p=0.02）。
腹腔镜肿瘤剜除术不会增加 CR-POPF 风险，并在选择的患者中具有较短 LOS 的优势。肿瘤位置和与胰管的关系指导手术决策。这些发现强调了肿瘤特异性标准，这将受益于微创方法。
