Islet cell tumor of the pancreas

McMillan, Foster L.; Scheibe, John R.

doi:10.1016/0002-9610(51)90404-7

Cited by 36 publications

(5 citation statements)

References 8 publications

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“…During surgery, most surgeons do not use any localization method except a meticulous surgical exploration and palpation of the gland. Glucose monitoring, described in 1951 [16], cannot be called a localization procedure, but it informs the surgeon with a more than 90% accuracy whether all insulinoma tissue had been resected [1,2,5]. Ultrasound during surgery with surgical exploration allows insulinomas to be localized in 90-100% of patients [15,17].…”

Section: Discussionmentioning

confidence: 99%

Surgery for benign insulinoma: An international review

et al. 1990

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In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5%.

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Section: Discussionmentioning

confidence: 99%

Surgery for benign insulinoma: An international review

et al. 1990

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“…Intraoperative insulin levels in the portal vein and its branches [32] are very expensive and should only be used in patients when the preoperative localization studies were negative and the tumor was not palpable at laparotomy. Sequential estimations of glucose and insulin in the peripheral blood [33][34][35] or in the portal vein [36,37] confirm excision of an insulinoma rather than intraoperative localization [38][39][40][41]. This test has the advantage of excluding, during exploration, the existence of a second insulinoma despite some false-positiVes [42], and of ensuring adequate pancreatic resection in cases of adult nesidioblastosis [43][44][45] (although the existence of this entity is denied by some authors) [46,47].…”

Section: Discussionmentioning

confidence: 99%

Preoperative imaging versus intraoperative localization of tumors in adult surgical patients with hyperinsulinemia: A multicenter study of 338 patients

Proye

Boissel

1988

World j. surg.

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Three hundred thirty-eight patients with organic hypoglycemia were referred to French-speaking surgeons during an 18-year period (1965)(1966)(1967)(1968)(1969)(1970)(1971)(1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983). Two hundred sixty-eight (79%) of these patients proved to have benign tumors (12 multiple), 37 (11%) had carcinoma, and 11 (3%) had "hyperplasia." Of the remaining 22 patients, 9 (2%) were not operated, 12 (4%) underwent negative pancreatic explorations, and 1 (0.3%) was misdiagnosed.The use of preoperative localization studies (computed tomographic scan, arteriography, ultrasound, and transhepatic portal sampling) were successful in 195 (62%) of 315 patients.Intraoperative diagnostic studies (blood sugar and insulin assays) in peripheral and portal blood, and intraoperative ultrasound were positive in 86% (265/305) of patients.We were commissioned by the French Association of Surgery to summarize the experience of French-speaking surgeons dealing with insulinoma since the advent of arteriography in 1965 [1]. The period of study was from 1965 to 1983. The focus for this report will be pre-and intraoperative imaging, and localization of insulinomas. MaterialAmong 338 cases collected, preoperative clinical and biochemical diagnoses were confirmed in 91% of patients. In an additional 6% of patients (20/338), the data were not conclusive; and of these 20 cases, 12 were eventually proven and 8 remained unconfirmed. In 3% of the patients (10/338), the data were not fully obtained nor documented for a diagnostic conclusion.Nine patients (2.7%) were not operated on, 12 (4%) patients underwent negative laparotomies, and 1 (0.3%) probably represents a misdiagnosis based on a factitious hypoglycemia. Pathologic review showed 268 cases (79%) were benign tumors (12 multiple), and 37 (11%) were carcinoma. In 11 patients (3%), islet hyperplasia was the final diagnosis.The locations of the tumors in these 305 proven cases are shown in Table 1. Of the solitary tumors identified, 44% were in Commissioned by the French Association of Surgery.

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“…A indicação cirúrgica em doentes com hipoglicemia orgânica baseiase nos seguintes fatos: a) ingestão contínua de hidratos de carbono que levaria à obesidade, por vezes mórbida, dificultando posteriormente o procedimento cirúrgico; b) hipoglicemias severas e repetidas, que provocariam deterioração corticocerebral irreversível, chegando mesmo a estados demenciais ou seqüelas neurológicas que exigem internações repetidas ou definitivas, mesmo após a cura cirúrgica da hipoglicemia; c) desconhecimento da natureza histopatológica da lesão (50) . A maioria dos serviços tem utilizado, além de administração de soluções glicosadas, a monitorização intra-operatória da glicemia (28) , recurso que, além de proteger o doente, orienta e caracteriza a remoção da lesão e o sucesso do procedimento (19) . A hiperglicemia, após remoção do insulinoma, foi observada em 91,6% dos doentes que compõem esta casuística.…”

Section: Discussionunclassified