Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases

Abstract

Laparoscopic surgery is a safe procedure for patients with benign insulinomas. The complication rates are comparable with those for laparotomy procedures. Relative to open operations, laparoscopic pancreas operations are associated with a more rapid postoperative recovery.

Laparoscopic surgery for pancreatic insulinomas: an update

“…Despite the fact that insulinomas are the most common functional PanNET, they still remain a rare clinical entity and consequently even large volume centers have a limited number of cases that are managed laparoscopically. 51,57,60,62 To our knowledge, no randomized control studies comparing open and laparoscopic management of insulinomas have been performed and are probably unlikely to be performed due to the paucity of cases. The majority of reports that attempt to make direct comparisons are retrospective in nature and therefore have certain limitations.…”

“…13,73,74 Larger tumors up to 3cm carry an increased risk for malignancy and increased rates of postoperative complications have been reported, thus consensus is lacking as to which approach is optimal. 57,59,75 Past series have reported successful application of laparoscopic techniques in the management of sporadic insulinomas located especially in the body or tail of the pancreas. 51,60,62,69 Concerns giving rise to debate still persist in the management of solitary lesions located in the head of the pancreas due to complications (up to 64% may develop a fistula) after enucleation.…”

“…The majority of reports that attempt to make direct comparisons are retrospective in nature and therefore have certain limitations. 56,57,59,63 Due to the relatively small number of cases there is difficulty in demonstrating significant differences in important issues such as complications rates. 19 Multicentric studies are plagued by interinstitution variability in preoperative management and expertise in advanced laparoscopic techniques.…”

“…61 Since then, numerous highly specialized centers have accrued experience in advanced laparoscopic techniques in pancreatic surgery and in these places most if not all procedures can be completed laparoscopically. 51,57,62,69 Pancreaticoduodenectomy remains a relative exception due to its complexity but is technically feasible in specialized institutions presenting acceptable results compared to open pancreaticoduodenectomy. 70,71 As a result, in high volume centers laparoscopic management has become the mainstay of surgical treatment due to several factors, including shorter length of stay and better cosmetic results.…”

“…76,77 A review of the literature indicates that laparoscopic enucleation when employed in selected patients is a technically feasible procedure with comparable complication rates. 51,57,63,71 The most common surgical complication is pancreatic fistula (7.2% in all types of laparoscopic procedures) with the majority occurring in laparoscopic enucleations. 19 Rates of pancreatic fistula after laparoscopic enucleation for various pathologies are variable (13%-56%) and may depend on the location of the lesion and its pathology.…”