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Benign Pancreatic Islet Cell Tumors: Resect or Enucleate?
John G. Touzios, Medical College of Wisconsin, Dept. of Surgery, Milwaukee, WI; James M. Kiely, Medical COllege of Wisconsin, Dept of Surgery, Milwaukee, WI; Susan C. Pitt, Medical College of Wisconsin, Milwaukee, WI; Stuart D. Wilson, Medical College of Wisconsin, Dept of Surgery, Milwaukee, WI; Henry A. Pitt, Indiana University School of Medicine, Dept of Surgery, Indianapolis, IN

For many years, surgeons were taught to enucleate benign pancreatic islet cell tumors. In recent years, however, the morbidity of pancreatic resection has diminished. As a result, pancreatic resection has become standard therapy, even for small, benign lesions. However, good data to compare resection with enucleation for pancreatic neuroendocrine tumors are not available. Therefore, the aim of this study is to document the morbidity and mortality as well as the short- and long-term outcome of resection versus enucleation for benign pancreatic islet cell tumors.

Methods:  Review of medical records over a 15-year period from 1990 to 2004 identified 65 patients with pancreatic islet cell tumors. These patients had a median age of 56 years, and 49% were female with a median tumor size of 2.0 cm. These tumors were located in the head/duodenum and body/tail in 46% and 54% of the patients, respectively, and were nonfunctional in 52%. Of these 65 patients, 31 (48%) had benign pancreatic islet cell tumors that came to surgery. Sixteen patients underwent resection whereas 15 were enucleated. These groups did not differ with respect to age, gender, or median tumor size, 1.9 cm versus 1.7 cm in the resected and enucleated groups. Tumors that were resected were more likely (p<0.05) to be in the body/tail, 63% versus 27% in the enucleated group. The operations included six pancreatoduodenectomies, ten distal pancreatectomies, eight of which included splenectomy, 13 enucleations, and two duodenal wall excisions. The two groups did not differ with respect to tumor type with the breakdown as follows:insulinoma (48%), non-functioning (39%), gastrinoma (7%), and glucagonoma (7%). Results: Operative time, blood loss, morbidity, mortality, length of hospital stay, and long term survival were:

	Op-Time (minutes)	Blood Loss (mL)	Morbidity	Mortality	LOS (days)	5-Yr. Surv.
Resection	280	493	25%	6.30%	11.1	94%
Enucleation	195*	209*	47%	0%	11.4	100%

   p <0.05 versus Resection Conclusion:  These data suggest that enucleation of benign pancreatic islet cell tumors is associated with 1) decreased operative time and blood loss as well as 2) operative morbidity, mortality, hospital stay, and long-term survival that is comparable to pancreatic resection. Therefore, we conclude that enucleation of small, benign, pancreatic islet cell tumors is an acceptable operative option.

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