Tags

Type your tag names separated by a space and hit enter

Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort.
Br J Surg. 2020 10; 107(11):1489-1499.BJ

Abstract

BACKGROUND

Insulinomas are found in 10-15 per cent of patients with multiple endocrine neoplasia type 1 (MEN1) and lead to life-threatening hypoglycaemia. Surgical outcome and the optimal surgical strategy for MEN1-related insulinoma are unknown.

METHODS

Patients with MEN1-related insulinomas were identified in 46 centres in Europe and North America between 1990 and 2016. Insulinomas were considered localized if the lesion was in the pancreatic head or body/tail. Patients with pancreatic neuroendocrine tumours throughout the pancreas were suspected of having multifocal insulinoma. The primary outcome was postoperative hypoglycaemia, defined as persistent hypoglycaemia, or recurrent hypoglycaemia caused by a new insulinoma or insulin-producing liver metastases. Hypoglycaemia-free survival was estimated by the Kaplan-Meier method.

RESULTS

Ninety-six patients underwent resection for MEN1-related insulinoma. Sixty-three and 33 patients had localized and multifocal insulinomas respectively. After a median follow-up of 8 (range 1-22) years, one patient (1 per cent) had persistent disease and six (6 per cent) had developed recurrent disease, of whom four had a new insulinoma. The 10-year hypoglycaemia-free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. Of those with localized disease, 46 patients underwent pancreatic resection and 17 enucleation. One of these patients had persistent disease and one developed recurrent insulinoma. Among patients with multifocal disease, three developed new insulinomas and two developed insulin-producing liver metastases.

CONCLUSION

Surgery for MEN1-related insulinoma is more successful than previously thought.

Authors+Show Affiliations

Department of Endocrine Surgical Oncology, Utrecht, the Netherlands.Department of Endocrine Surgical Oncology, Utrecht, the Netherlands. Department of Endocrine Oncology, Utrecht, the Netherlands.Imaging Division, University Medical Centre Utrecht, Utrecht, the Netherlands.Department of Endocrine Surgical Oncology, Utrecht, the Netherlands.Department of Endocrine Oncology, Utrecht, the Netherlands.No affiliation info availableDepartment of Endocrine Surgical Oncology, Utrecht, the Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32352164

Citation

van Beek, D J., et al. "Surgery for Multiple Endocrine Neoplasia Type 1-related Insulinoma: Long-term Outcomes in a Large International Cohort." The British Journal of Surgery, vol. 107, no. 11, 2020, pp. 1489-1499.
van Beek DJ, Nell S, Verkooijen HM, et al. Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort. Br J Surg. 2020;107(11):1489-1499.
van Beek, D. J., Nell, S., Verkooijen, H. M., Borel Rinkes, I. H. M., Valk, G. D., & Vriens, M. R. (2020). Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort. The British Journal of Surgery, 107(11), 1489-1499. https://doi.org/10.1002/bjs.11632
van Beek DJ, et al. Surgery for Multiple Endocrine Neoplasia Type 1-related Insulinoma: Long-term Outcomes in a Large International Cohort. Br J Surg. 2020;107(11):1489-1499. PubMed PMID: 32352164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort. AU - van Beek,D J, AU - Nell,S, AU - Verkooijen,H M, AU - Borel Rinkes,I H M, AU - Valk,G D, AU - ,, AU - Vriens,M R, AU - ,, Y1 - 2020/04/30/ PY - 2019/12/20/received PY - 2020/02/09/revised PY - 2020/03/19/accepted PY - 2020/5/1/pubmed PY - 2021/3/2/medline PY - 2020/5/1/entrez SP - 1489 EP - 1499 JF - The British journal of surgery JO - Br J Surg VL - 107 IS - 11 N2 - BACKGROUND: Insulinomas are found in 10-15 per cent of patients with multiple endocrine neoplasia type 1 (MEN1) and lead to life-threatening hypoglycaemia. Surgical outcome and the optimal surgical strategy for MEN1-related insulinoma are unknown. METHODS: Patients with MEN1-related insulinomas were identified in 46 centres in Europe and North America between 1990 and 2016. Insulinomas were considered localized if the lesion was in the pancreatic head or body/tail. Patients with pancreatic neuroendocrine tumours throughout the pancreas were suspected of having multifocal insulinoma. The primary outcome was postoperative hypoglycaemia, defined as persistent hypoglycaemia, or recurrent hypoglycaemia caused by a new insulinoma or insulin-producing liver metastases. Hypoglycaemia-free survival was estimated by the Kaplan-Meier method. RESULTS: Ninety-six patients underwent resection for MEN1-related insulinoma. Sixty-three and 33 patients had localized and multifocal insulinomas respectively. After a median follow-up of 8 (range 1-22) years, one patient (1 per cent) had persistent disease and six (6 per cent) had developed recurrent disease, of whom four had a new insulinoma. The 10-year hypoglycaemia-free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. Of those with localized disease, 46 patients underwent pancreatic resection and 17 enucleation. One of these patients had persistent disease and one developed recurrent insulinoma. Among patients with multifocal disease, three developed new insulinomas and two developed insulin-producing liver metastases. CONCLUSION: Surgery for MEN1-related insulinoma is more successful than previously thought. SN - 1365-2168 UR - https://www.unboundmedicine.com/medline/citation/32352164/Surgery_for_multiple_endocrine_neoplasia_type_1_related_insulinoma:_long_term_outcomes_in_a_large_international_cohort_ L2 - https://doi.org/10.1002/bjs.11632 DB - PRIME DP - Unbound Medicine ER -