Clinical outcomes of 15 consecutive patients who underwent laparoscopic insulinoma resection: The usefulness of monitoring intraoperative blood insulin during laparoscopic pancreatectomy

Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

doi:10.1111/ases.12187

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…Previous studies have demonstrated that intraoperative insulin monitoring can reliably evaluate the complete removal of insulinomas (21,30). However, these studies mainly described the application of insulin level.…”

Section: Discussionmentioning

confidence: 99%

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The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

Liu

Jiang

Cheng

et al. 2021

Preprint

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Background The blood glucose level is an important biochemical parameter for evaluating the resection effectiveness of insulinomas. However, whether other biochemical parameters have better evaluating ability remains unclear. The current study aims to compare the evaluating capability of blood glucose and insulin levels at several aspects, such as the accuracy and response time. Methods Between September 2017 and July 2018, 21 insulinoma patients with single tumor who underwent surgical resection were enrolled. Peripheral venous blood samples were assayed for blood glucose and insulin levels on the day of surgery and at 30 minutes, 60 minutes, 1 day, and 7 days after surgery. The evaluating abilities of blood glucose and insulin levels for resection effectiveness were recorded and compared. Results The evaluating performance of the insulin level was better than that of the blood glucose level (100% for 21 patients vs 82.4% for 17 patients), as well as the response time ( p<0.0001). Furthermore, the insulin level was not effected by intravenous glucose infusion compared to the blood glucose level. Conclusions Comparing with blood glucose level, insulin level is a better parameter for evaluating resection effectiveness of insulinomas with faster response and regardless of perioperative intravenous glucose infusion.

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Section: Discussionmentioning

confidence: 99%

“…Failure to achieve symptomatic improvement after resection has been associated with worse recurrence-free survival (RFS) (20). Considering these points together, surgeons should con rm resection outcomes after the surgical procedure (21).…”

Section: Introductionmentioning

confidence: 99%

The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

Liu

Jiang

Cheng

et al. 2021

Preprint

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“…When insulinomas were considered separately, the mean detection rate of EUS was 86% (range 57-100) in 12 studies including 250 patients [63,64,72,[77][78][79][80][81][82][83][84][85] and that of IOUS was 92% (range 84-100) in 9 studies including 264 patients [66,75,76,[86][87][88][89][90][91] . For duodenal tumors and lymph node metastases, the detection rate of US was 18% in a study of 25 patients [66] and that of EUS 63% in 2 studies comprising 59 patients [66,72] .…”

Section: Sensitivity Specificity and Detection Ratesmentioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

et al. 2017

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Contrast-enhanced computed tomography (CT) of the neck-thorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CT-guided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which ⁶⁸Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. ¹⁸FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.

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“…Once all tumor tissue is successfully removed, blood glucose should increase by approximately 30 mg/dL within 30 min and plateau after about 60 min [ 56 ]. Correspondingly, the blood insulin level should sharply fall within 30 min after tumor resection [ 57 ].…”

Section: Intraoperative Localizationmentioning

confidence: 99%

Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling

Zhao

Patel

Kulkarni

et al. 2020

JCM

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Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure’s technical success and proper interpretation of its results is dependent on the interventional radiologist’s knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.

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Clinical outcomes of 15 consecutive patients who underwent laparoscopic insulinoma resection: The usefulness of monitoring intraoperative blood insulin during laparoscopic pancreatectomy

Abstract: Complete removal of an insulinoma can be reliably predicted by intraoperative blood insulin monitoring even in laparoscopic pancreatectomies.

Cited by 10 publications

References 34 publications

The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling

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