Is Laparoscopic Resection Adequate in Patients with Neuroendocrine Pancreatic Tumors?

Fernández‐Cruz, Laureano; Blanco, L.; Cosa, Rebeca; Rendón, Héctor

doi:10.1007/s00268-008-9467-2

Cited by 189 publications

(183 citation statements)

References 98 publications

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“…48 In several series its sensitivity in localizing insulinoma is higher than 90% and considered superior to preoperative imaging studies, it being able to detect lesions as small as 2-3mm. 15,[49][50][51] It is hence is easy to understand that in laparoscopic surgery where there is typically a loss of tactile sensation, IOUS gains even greater importance with results being comparable to IOUS in open surgery. [52][53][54] A lack of laparoscopic IOUS, despite positive preoperative identification, has been cited as an important factor in the failure to intraoperatively identify lesions leading to increased incidences of conversion to open procedure.…”

Section: Localization Of the Tumormentioning

confidence: 99%

“…51,[58][59][60][61] Insulinomas constitute a distinct category, since the majority are benign, solitary and usually small in size at the time of diagnosis (<2cm). Thus, common sense dictates that they are more amenable to laparoscopic intervention than other PanNETs.…”

Section: Open or Laparoscopic Approach?mentioning

confidence: 99%

“…Despite the fact that insulinomas are the most common functional PanNET, they still remain a rare clinical entity and consequently even large volume centers have a limited number of cases that are managed laparoscopically. 51,57,60,62 To our knowledge, no randomized control studies comparing open and laparoscopic management of insulinomas have been performed and are probably unlikely to be performed due to the paucity of cases. The majority of reports that attempt to make direct comparisons are retrospective in nature and therefore have certain limitations.…”

Section: Open or Laparoscopic Approach?mentioning

confidence: 99%

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Laparoscopic surgery for pancreatic insulinomas: an update

Aggeli¹,

Nixon²,

Karoumpalis³

et al. 2016

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Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

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Section: Localization Of the Tumormentioning

confidence: 99%

Section: Open or Laparoscopic Approach?mentioning

confidence: 99%

Section: Open or Laparoscopic Approach?mentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic surgery for pancreatic insulinomas: an update

Aggeli¹,

Nixon²,

Karoumpalis³

et al. 2016

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“…10,13 In 3 patients, an enucleation of the tumor was carried out, a procedure generally considered when the morphology is known to be a PancNET rather than the more aggressive ductal adenocarcinoma. Fine-needle aspiration allows the surgical team to carry out a simpler, parenchyma-preserving operation with all the attendant benefits for the patient.…”

Section: Follow-upmentioning

confidence: 99%

“…These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation. [10][11][12][13] Herein, we report on the utility and limitations of FNA in the preoperative evaluation and management of PancNETs in light of these developments.…”

mentioning

confidence: 99%

Role of Fine-Needle Aspiration in the Surgical Management of Pancreatic Neuroendocrine Tumors: Utility and Limitations in Light of the New World Health Organization Classification

Moyana

Kendal

Chatterjee

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Pancreatic neuroendocrine tumors (PancNETs) are rare and tend to get overshadowed by their more prevalent and aggressive ductal adenocarcinoma counterparts. The biological behavior of PancNETs is unpredictable, and thus management is controversial. However, the new World Health Organization classification has significantly contributed to the prognostic stratification of these patients. Concurrently, there have been advances in surgical techniques for benign or lowgrade pancreatic tumors. These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation.Objective.-To report on the utility and limitations of fine-needle aspiration in the preoperative evaluation and management of PancNETs.Design.-This was a retrospective review of our institutional tumor database from 2002 to 2012. There were 25 cases of PancNETs that were localized and staged by medical imaging and diagnosed by fine-needle aspiration.Results.-Fourteen patients underwent laparotomy, with some requiring only limited surgery; 4 had laparoscopic resections; 4 were serially observed without surgical intervention; and another 3 were inoperable. After a mean follow-up of 37 months, more than half of the patients had no evidence of disease, including most of those who underwent minimally invasive surgery.Conclusions.-Fine-needle aspiration is a useful diagnostic adjunct to medical imaging in the preoperative evaluation and management of PancNETs. However, there are limitations with regard to grading PancNETs using this technique.(Arch Pathol Lab Med. 2014;138:896-902; doi: 10.5858/ arpa.2013-0300-OA) C ross-sectional imaging, endoscopic ultrasound (EUS), and fine-needle aspiration (FNA) are important in the preoperative evaluation of pancreatic masses.1-4 Although the majority of pancreatic tumors are ductal adenocarcinomas, other neoplasms such as neuroendocrine tumors, acinar cell carcinomas, solid pseudopapillary neoplasms, cystic neoplasms, and metastases also occur. 5,6 Pancreatic neuroendocrine tumors (PancNETs) are a particularly interesting group of neoplasms because they can present clinically with neuroendocrine manifestations or remain silent until their presence is heralded by mass effect. They can be single and sporadic or can be a component of several syndromes.2-4 The biological behavior of PancNETs is unpredictable, especially in the absence of locoregional spread or metastases. Thus, the management is controversial. However, there is now a growing consensus that the new World Health Organization (WHO) classification has significantly contributed to the prognostic stratification of these patients.7-9 Concurrently, there have been advances in surgical techniques for benign or low-grade pancreatic tumors. These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation.10-13 Herein, we report on the utility and limitations of FNA in the preoperative evaluation and management of PancNETs in light of these developments. MATERIALS AND METHO...

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