Laparoscopic approach for solitary insulinoma: a multicentre study

Ayav, Ahmet; Bresler, L.; Brunaud, Laurent; Boissel, P; Sfcl,; Afce,

doi:10.1007/s00423-004-0526-3

Cited by 133 publications

(140 citation statements)

References 26 publications

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“…With advances in laparoscopic techniques, an increasing number of successful laparoscopic resections for insulinomas is reported in the literature [10,11,12,20,21,22,23,24,25,26,27]. In 7 of our patients undergoing successful laparoscopic resection, the tumors were located in body or tail of the pancreas.…”

Section: Discussionmentioning

confidence: 92%

Strategy for the Surgical Management of Insulinomas: Analysis of 52 Cases

Liu¹,

Peng

Zhang

et al. 2007

Dig Surg

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Aim: The goal of this retrospective study was to analyze the strategy for the surgical management of insulinomas. Methods: From May 2000 to October 2006, the medical records of 52 patients with insulinomas were retrospectively studied. Results: All tumors were localized precisely by imaging techniques combined with intraoperative palpation. Forty-eight patients with benign lesions underwent surgical treatment: 41 patients open and 7 patients laparoscopic procedures. Four patients with malignant insulinomas underwent tumor resection; 3 of them underwent metastatic lesion and/or lymph node dissection. There were no discrepancies regarding operation time, blood loss, and complication rate between open enucleation and laparoscopic surgery. The mean hospital stay was 11.8 ± 3.4 days after laparoscopic surgery, shorter than the 17.0 ± 6.0 days after the open approach. Twenty-two complications occurred in 17 patients (32%) following resection. On follow-up, 86% of the patients were free from symptoms, and surgical cure was achieved in 95% of the patients with benign insulinomas. Conclusions: The choice of the surgical strategy for the treatment of pancreatic insulinomas depends on size and location of the tumor and the risk of malignancy. The optimal surgical procedure is key to prevent postoperative complications. The laparoscopic approach is safe and feasible for patients with benign tumors located in body or tail of the pancreas.

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Section: Discussionmentioning

confidence: 92%

Strategy for the Surgical Management of Insulinomas: Analysis of 52 Cases

Liu¹,

Peng

Zhang

et al. 2007

Dig Surg

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“…An alternative approach in those facile with laparoscopic surgery and laparoscopic ultrasonography would be to perform laparoscopic pancreatic ultrasonography. 28,29 If one demonstrates a clear-cut insulinoma, then proceeding with enucleation or resection would be appropriate. 30,31 On the other hand, if laparoscopic ultrasonography was negative, again, we would recommend cessation of the operation, performance of a selective arterial stimulation test, followed by return to the operating room for a gradient-guided resection.…”

Section: Discussionmentioning

confidence: 99%

What should be done in an operating room when an insulinoma cannot be found?

Rostambeigi

Thompson

2009

Clinical Endocrinology

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SummaryInsulinoma is the most common (functioning) islet cell tumour of the pancreas and is highly curable with accurate localization and precise extirpation of the often benign, solitary lesion. Although previous reports describe high success rates without pre-operative localization, more recent recognition of the overlap among causes of endogenous hyperinsulinism, coupled with the deleterious long-term effects of blind distal pancreatectomy and re-operation, mandate the need for precise pre-operative localization or regionalization of the tumour(s). If these criteria have not been met and the surgeon finds him/herself in the operating room without a localized or regionalized tumour, the operation should be concluded without resection, the diagnosis reconfirmed, and a calcium stimulation test performed. At experienced centres, this can be often carried out within 24 -48 h and the patient returned to the operating room for a gradient-guided resection. Intraoperative venous sampling for insulin might be an option in the future but its accuracy has not been validated in sufficient numbers of patients to date. Insulinoma is the most common functioning endocrine tumour of the pancreas, seen in approximately four persons per 1 000 000 persons/year. More than 90% of insulinomas are benign, solitary, and < 2 cm in diameter. Importantly, insulinomas are equally distributed throughout the gland. The female : male ratio is approximately 3 : 2. Less than 10% are seen in association with the multiple endocrine neoplasia type 1 (MEN1) syndrome, and 5-10% of tumours are malignant.1,2 Mean age at presentation is approximately 45 years.Multiple insulinomas can be seen in 2-3% of sporadic cases but are more often seen in the MEN1 syndrome; although the insulinsecreting tumour itself is very often solitary.3,4The diagnosis of insulinoma can be challenging. 5,6 Although originally considered to present only in the fasting state or with exercise, it is now known that patients with an insulinoma can present with postprandial symptoms as well. Patients may have nonspecific adrenergic symptoms, which include anxiety, sweating and palpitations, but true organic endogenous hyperinsulinism is characterized by neuroglycopaenic symptoms that include confusion, amnesia, visual disturbances, seizures and coma. The diagnosis of endogenous hyperinsulinism is dependent on the satisfaction of Whipple's triad and remains the cornerstone of the screening process: hypoglycaemia (plasma glucose < 50 mg/dl), neuroglycopaenic symptoms, and prompt relief of symptoms with the administration of glucose define Whipple's triad. 2 Once Whipple's triad has been satisfied, the patient should be fasted either formally (72-h fast) or informally (outpatient) to a plasma glucose < 50 mg/dl with concomitant documentation of inappropriate β -cell polypeptides (insulin, C-peptide, and proinsulin). With a glucose level ≤ 45 mg/dl, an insulin level ≥ 3 μ IU/ml and a C-peptide level of ≥ 200 pmol/l, the endogenous nature of the hyperinsulinism is confirmed. It is impor...

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“…Although the majority of the interventions have been made using open surgery, laparoscopic surgery is a surgical option in some centers with a morbidity rate comparable with that for the open approach. When the tumor is not found during laparoscopy, laparoscopic ultrasonography seems to be the most efficient tool to localize it and probably to prevent conversion (35,36). Those tumors located in the body or tail of the pancreas can better benefit from the laparoscopic approach (37).…”

Section: Insulin-secreting Tumorsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: A clinical update on tumor-induced hypoglycemia

Iglesias

Díez

2014

European Journal of Endocrinology

140

144

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Tumor-induced hypoglycemia (TIH) is a rare clinical entity that may occur in patients with diverse kinds of tumor lineages and that may be caused by different mechanisms. These pathogenic mechanisms include the eutopic insulin secretion by a pancreatic islet b-cell tumor, and also the ectopic tumor insulin secretion by non-islet-cell tumor, such as bronchial carcinoids and gastrointestinal stromal tumors. Insulinoma is, by far, the most common tumor associated with clinical and biochemical hypoglycemia. Insulinomas are usually single, small, sporadic, and intrapancreatic benign tumors. Only 5-10% of insulinomas are malignant. Insulinoma may be associated with the multiple endocrine neoplasia type 1 in 4-6% of patients. Medical therapy with diazoxide or somatostatin analogs has been used to control hypoglycemic symptoms in patients with insulinoma, but only surgical excision by enucleation or partial pancreatectomy is curative. Other mechanisms that may, more uncommonly, account for tumor-associated hypoglycemia without excess insulin secretion are the tumor secretion of peptides capable of causing glucose consumption by different mechanisms. These are the cases of tumors producing IGF2 precursors, IGF1, somatostatin, and glucagon-like peptide 1. Tumor autoimmune hypoglycemia occurs due to the production of insulin by tumor cells or insulin receptor autoantibodies. Lastly, massive tumor burden with glucose consumption, massive tumor liver infiltration, and pituitary or adrenal glands destruction by tumor are other mechanisms for TIH in cases of large and aggressive neoplasias.

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Laparoscopic approach for solitary insulinoma: a multicentre study

Cited by 133 publications

References 26 publications

Strategy for the Surgical Management of Insulinomas: Analysis of 52 Cases

Strategy for the Surgical Management of Insulinomas: Analysis of 52 Cases

What should be done in an operating room when an insulinoma cannot be found?

MANAGEMENT OF ENDOCRINE DISEASE: A clinical update on tumor-induced hypoglycemia

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