Enucleation for insulinoma: consolidating evidence through systematic review and meta-analysis

Abstract

Background: Pancreas-preserving procedures such as enucleation (EN) are indicated for select patients with insulinomas. Despite the increasing popularity of EN, no consensus has been reached on the preferred surgical approach for the management of insulinomas. The aim of this meta-analysis of proportions is to evaluate the safety and efficacy of EN for patients with pancreatic insulinoma. Methods: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched from database inception to December 2023. The pooled mean and proportions were analyzed using a random-effects model. The review was registered prospectively with PROSPERO (CRD42024492786). Results: Twenty-one studies with 803 patients met the inclusion criteria. The pooled mean tumor diameter was 1.5 cm (95%CI: 1.3-1.6). The pooled mean operative time was 142 min (95%CI: 118-166), postoperative hospital stay was 9.5 days (95% CI: 7.2-11.7), and estimated blood loss (EBL) was 71.3 mL (95% CI: 47.3-95.3). The overall postoperative occurrence rate was 37.3% (95%CI: 0.264-0.481, I2 = 92%, n = 277), including 27% (95%CI: 0.179-0.360, I2 = 90%, n = 176) with any postoperative pancreatic fistula (POPF) and 1.5% (95%CI: 0.000-0.030, I2 = 0%, n = 4) with new-onset diabetes. Additionally, the pooled overall recurrence rate was 3.1% (95%CI: 0.016-0.045, I2 = 7%, n = 31), and the pooled rate of postoperative mortality was 1.1% (95%CI: 0.002-0.023, I2 = 0%, n = 6). Conclusion: EN appears safe and effective in managing pancreatic insulinoma for selected patients, with low rates of grade C POPF and recurrence. Despite the promising results, more selective criteria based on the location of insulinoma with a larger sample size and extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.