INSULINOMA NEW CONCEPTS IN MANAGEMENT

In this report, nine patients with insulinoma who were operated on between 19H5 and I <J<J3 at the Shohada Medical Center affiliated to the Shahid Beheshti University of Medical Sciences in Tehran are presented. There were three males and six females (male to female ratio I :2) and the patients' age ranged from 23 to 60 years old (mean age 37.6 years old). Duration of symptoms was from three months to three years (average 18.2 months) and consisted of weakness, fainting, cold sweats, tremor, syncope, seizures and coma. Preoperative localization procedures consisting of sonography, CT scan and selective angiography were performed for all patients and at least one of them was positive in five patients (55%), with CT scan being the most helpful. At surgery, II tumors were found in seven patients, (78% positive surgical findings), of which two were in the head, four in the body and five in the tail of the pancreas. Of the two patients in whom no tumor was found at surgery, one patient who underwent 95% pancreatectomy with preservation of the spleen was cured and nonnoglycemic postoperatively, but the second patient, despite a distal pancreatectomy up to the level of the superior mesenteric vein, remained symptomatic. Thus our overall success rate is HR.<J%. The surgical procedures performed consisted of distal pancreatectomy with splenectomy in three patients, enucleation alone in three patients, distal pancreatectomy preserving the spleen in two patients and distal pancreatectomy with enucleation in one patient. Insulinoma is a surgically correctable disease, but requires a high index of suspicion if 'diagnosis is not to be delayed and severe neurological sequelae prevented. Tumor enucleation when possible or distal subtotal pancreatectomy preserving the spleen as described in detail are recommended by the authors as the procedures of choice, and with careful technique, excellent results are possible. In this paper, we present nine patients treated at our center and compare our results with that reported in the literature.