P-0148 - Presentation of Insulinoma in developing world

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Neuroendocrine Cancers
Cancer Aetiology, Epidemiology, Prevention
Presenter Manish Kaushal
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors M. Kaushal
  • MGM Medical College, Indore/IN

Abstract

Introduction

The aim of this study was to describe the localization and management of patients with pancreatic insulinomas and determine the most effective localization and surgical techniques in the presence of significant financial constraints in the patient population. Insulinoma is uncommon endocrine tumors that have a prevalence of around 1 per 100,000 person-years. However; they represent the most common functioning endocrine tumor of the pancreas and is the main cause for hypoglycemia due to endogenous hyperinsulinism.

Methods

We performed an analysis of a clinical series in order to study the clinical and biological spectrum of presentation, the preoperatory imagistic diagnosis and results of the surgical approach in a backward and poor infrastructure set up in central India.

Results

Between 2002-20013, 07 patients with symptoms suggesting an insulinoma were hospitalized in our department. All cases were presented with neuroglycopenic symptoms and 5 had history of unconsciousness. Preoperatory localization of insulinomas was possible in 5 patients. Intraoperatory ultrasound was performed in 2 patients. Enucleation was performed in 5 cases while in one case tumor was not palpable during the time of surgery patient underwent blind distal pancreactomy and in one case multiple tumors were present in distal pancreas so distal pancreactomy done. The dimensions of the tumor were more than 2 cm in most of the patients of enucleation group; 1 had multiple insulinomas; In 6 cases patients proved to have benign insulinomas at histological specimens. Following surgery, the symptoms disappear in all patients except one. The most common complication after enucleation was pancreatic fistula seen in one case.

Conclusion

Presentation of Insulinoma in developing country is delayed due to late diagnosis and most of cases tumor size was more than 2 cm. Patients are younger and have aggressive neuroglycopenic symptoms.