Outcomes and quality of life after partial pancreatectomy for noninsulinoma pancreatogenous hypoglycemia from diffuse islet cell disease

Background: Noninsulinoma pancreatogenous hypoglycemia (NIPH) is a rare cause of hypoglycemia, especially affecting postbariatric surgery patients, related to excessive insulin secretion. Partial pancreatectomy controls hypoglycemia in the early postoperative period; however, multiple patients have experienced symptomatic relapse. The study goal was to assess frequency and severity of recurrent symptoms in operated patients. Methods: All patients who underwent pancreatic resection for NIPH at Mayo Clinic from January 1996 through December 2008 were reviewed for demographics, preoperative testing, operative and postoperative details. Data from patient records, mail survey, European Quality of Life Survey (EQ-5D), and Fear of Hypoglycemia Scale (FOHS) were used to assess outcome. Results: Seventy-five patients underwent pancreatic resection for NIPH (5 dead, 1 incarcerated). 48 patients (70%) completed the survey; mean follow-up, 53 months. Median time to recurrent symptoms was 16 months in 41 patients (87%). Despite symptom recurrence, 36 patients (75%) reported overall improvement in symptoms and quality of life (QOL); median EQ-5D health scores increased from 40 to 75 out of 100 (P < .001). Moreover, they reported marked reduction in psychologic stress and hypoglycemic symptoms with greater than 50% decrease in FOHS overall, worry, and behavioral median scores (P < .001). Overall, half of the patients were classified as highly/moderately surgically successful, whereas the other half was minimally successful or surgical failures. Conclusion: Although nearly 90% of NIPH patients reported recurrent symptoms suggestive of hypoglycemia, a majority reported improvements in QOL and marked reduction in other symptoms after pancreatic resection. Nevertheless, 25% of patients experienced no benefit from partial pancreatectomy.