SURGICAL EXPERIENCE WITH PANCREATIC ISLET-CELL TUMORS

Objective: To review the surgical management of pancreatic islet-cell tumors, with attention to preoperative localization, surgical therapy, and postoperative survival. Design: Consecutive case series of patients treated surgically for pancreatic islet-cell tumor. Setting: The Johns Hopkins Hospital, a large teaching hospital in Baltimore, Md, serving both as a primary and tertiary care center. Patients: Thirty-seven patients with pancreatic islet-cell tumors treated surgically between 1979 and 1990. Main Outcome Measures: Success of preoperative localization studies, types of operations performed, and postoperative survival. Results: Preoperative computed tomography correctly localized the tumor in 20 of 34 patients (59%); angiography in 21 of 28 patients (75%), and the combination of computed tomography and angiography in 23 of 28 patients (82%). Benign islet-cell tumors were found in 19 patients, and malignant tumors in 18 patients. Twenty-four patients (65%) had functional tumors. The proportion of patients with nonfunctioning tumors increased from 0% before 1984, to 43% from 1985 to 1990. Surgical therapy was curative in 27 patients and palliative in 10. The most commonly performed operative procedures were tumor enucleation (11 patients [30%]), distal pancreatectomy (10 patients [27%], and pancreaticoduodenectomy (10 patients [27%]). There was no operative mortality. The actuarial survival at 40 months was 100% in patients with benign tumors and significantly lower (66%) in patients with malignant tumors. Conclusions: This experience from a single institution underscores the role of preoperative localization studies and appropriate surgical management of these rare tumors.