Delphine Vezzosi1, Catherine Cardot-Bauters1, Nicolas Bouscaren1, Maëlle Lebras1, Mireille Bertholon-Grégoire1, Patricia Niccoli1, Nathalie Levy-Bohbot1, Lionel Groussin1, Philippe Bouchard1, Antoine Tabarin1, Philippe Chanson1, Pierre Lecomte1, Isabelle Guilhem1, Nicolas Carrere1, Eric Mirallié1, François Pattou1, Jean Louis Peix1, Diane Goere1, Françoise Borson-Chazot1, Philippe Caron1, Vanina Bongard1, Bruno Carnaille1, Pierre Goudet1, Eric Baudin2. 1. Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France. 2. Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France eric.baudin@gustaveroussy.fr.
Abstract
OBJECTIVE: Management of insulinomas in the context of MEN1 remains poorly studied. The aim of this study was to evaluate long-term results of various surgical approaches in a large cohort of insulinoma-MEN1 patients. DESIGN AND METHODS: Consecutive insulinoma-MEN1 patients operated on for a nonmetastatic insulinoma between 1957 and 2010 were retrospectively selected from the MEN1 database of the French Endocrine Tumor Group. The type of surgery was categorized as distal pancreatectomy (DP), total pancreatectomy/cephalic duodenopancreatectomy (TP/CDP), or enucleation (E). Primary endpoint was time until recurrence of hypoglycemia after initial surgery. Secondary endpoints were post-operative complications. RESULTS: The study included 73 patients (median age=28 years). Surgical procedures were DP (n=46), TP/CDP (n=9), or E (n=18). After a median post-operative follow-up of 9.0 years (inter-quartile range (IQR): 2.5-16.5 years), 60/73 patients (82.2%) remained hypoglycemia free. E and TP/CDP were associated with a higher risk of recurrent hypoglycemia episodes (unadjusted hazard ratio: 6.18 ((95% CI: 1.54-24.8); P=0.010) for E vs DP and 9.51 ((95% CI: 1.85-48.8); P=0.007) for TP/CDP vs DP. After adjustment for International Union against Cancer pTNM classification, enucleation remained significantly associated with a higher probability of recurrence. Long-term complications had occurred in 20 (43.5%) patients with DP, five (55.6%) with TP/CDP, but in none of the patients who have undergone E (P=0.002). CONCLUSION: In the French Endocrine database, DP is associated with a lower risk for recurrent hypoglycemia episodes. Due to lower morbidity, E alone might be considered as an alternative.
OBJECTIVE: Management of insulinomas in the context of MEN1 remains poorly studied. The aim of this study was to evaluate long-term results of various surgical approaches in a large cohort of insulinoma-MEN1patients. DESIGN AND METHODS: Consecutive insulinoma-MEN1patients operated on for a nonmetastatic insulinoma between 1957 and 2010 were retrospectively selected from the MEN1 database of the French Endocrine Tumor Group. The type of surgery was categorized as distal pancreatectomy (DP), total pancreatectomy/cephalic duodenopancreatectomy (TP/CDP), or enucleation (E). Primary endpoint was time until recurrence of hypoglycemia after initial surgery. Secondary endpoints were post-operative complications. RESULTS: The study included 73 patients (median age=28 years). Surgical procedures were DP (n=46), TP/CDP (n=9), or E (n=18). After a median post-operative follow-up of 9.0 years (inter-quartile range (IQR): 2.5-16.5 years), 60/73 patients (82.2%) remained hypoglycemia free. E and TP/CDP were associated with a higher risk of recurrent hypoglycemia episodes (unadjusted hazard ratio: 6.18 ((95% CI: 1.54-24.8); P=0.010) for E vs DP and 9.51 ((95% CI: 1.85-48.8); P=0.007) for TP/CDP vs DP. After adjustment for International Union against Cancer pTNM classification, enucleation remained significantly associated with a higher probability of recurrence. Long-term complications had occurred in 20 (43.5%) patients with DP, five (55.6%) with TP/CDP, but in none of the patients who have undergone E (P=0.002). CONCLUSION: In the French Endocrine database, DP is associated with a lower risk for recurrent hypoglycemia episodes. Due to lower morbidity, E alone might be considered as an alternative.
Authors: Jerena Manoharan; Friedhelm Raue; Caroline L Lopez; Max B Albers; Carmen Bollmann; Volker Fendrich; Emily P Slater; Detlef K Bartsch Journal: World J Surg Date: 2017-08 Impact factor: 3.352