Laparoscopic Surgery for an Endometrial Cancer Patient Treated with Everolimus for Insulinoma: A Case Report

Abstract

Everolimus, an orally administrated mammalian target of rapamycin (mTOR) inhibitor, was used for treatment of insulinoma (functioning pancreatic neuroendocrine tumor) because of anti-tumor and anti-insulin activities. However, patients receiving surgical procedures during oral everolimus therapy are at increased risks of postoperative adverse events. Everolimus is known to increase risks of wound infection and dehiscence due to immunosuppressive and anti-angiogenesis effects. In addition, interruption of oral everolimus therapy in a perioperative period may result in hypoglycemia. Here we report a 43-year-old woman who underwent laparoscopic surgery for early stage endometrial cancer during oral everolimus therapy for multiple liver metastases of malignant insulinoma. Although her life-limiting factor was considered to be metastatic insulinoma, hysterectomy was required to control vaginal bleeding. Laparoscopic hysterectomy was successfully performed. Wound infection, hypoglycemia or other postoperative adverse events did not occur. We consider that laparoscopic surgery for the present case had several advantages over laparotomy because (1) small surgical wounds reduced risks of wound infection and dehiscence and (2) early oral feeding was helpful for preventing postoperative hypoglycemia.