Laparoscopic Enucleation of Pancreatic Insulinomas

Abstract

Insulinomas are rare endocrine pancreatic tumors whose incidence has been increasing in recent years owing to early detection by clinical and radiologic, such as remote neural monitoring, computed tomography (CT), and ultrasound (US) findings. The classical treatment consists of open surgical resection, which is associated with relative morbidity and mortality rates. The aim of this paper was to present 5 patients who were diagnosed with pancreatic insulinomas that were treated by laparoscopic resection. Five (5) patients, ranging from 14 to 45 years and presenting with classical Whipple Triad, had lesions ranging from 1.5 to 2.5 cm by CT (body and tail of the pancreas), which were subsequently diagnosed as insulinomas. An ecoendoscopy showed no combined lesions. They were treated by a laparoscopic resection. Glicemic levels were controlled during surgery with an expected glucose rise. All patients had an uneventfull recovery. The mean length of follow-up is 14 months. The laparoscopic resection of pancreatic insulinomas is a reliable procedure for superficial lesions in the body and tail of the pancreas.

Laparoscopic surgery for pancreatic lesions: current status and future

“…However, many high-degree malignant cases, such as pancreatic ductal adenocarcinoma, were also reported in Lap PD. Lap EN is mostly applied to insulinoma and some rare cases, such as nonfunctioning neuroendocrine tumors [16][17][18]. Mabrut [19] reviewed 127 laparoscopic pancreatic operations in 25 European medical centers and found that 87% of the cases were benign tumors.…”

“…The average hospital stay was 18 days (range: 7-39 days), and the average conversion rate was 46% (range: 12%-100%). The mean number of lymph nodes in the pathology was 19 (range: [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The complication rates were 16% and mortality was recorded in only 2 (1.3%) patients during the perioperative period.…”

Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique

“…Many authors advocate surgical resection for all the symptomatic cysts, not only for the relief of symptoms but also because of the higher potential for malignancy in this subset of patients [1]. In contrast, incidental pancreatic cysts, despite their lower risk of malignancy, cannot be ignored because many investigators have demonstrated that a significant proportion of these could be either malignant or premalignant [1][2][3].…”

“…PNTs comprise a rare group of neoplasms with complex patterns of behavior requiring detailed specialist management (e.g., insulin, gastrin, glucagon, vasoactive intestinal peptide, corticotropin) that can cause distinct clinical syndromes [1][2][3], and surgery remains the only curative modality currently available for resectable PNTs [2]. However, most pancreatic neuroendocrine tumors are nonfunctional, and they are generally hard to diagnose until symptoms develop from a mass effect or from metastatic disease.…”

“…Benign PNTs may be treated with enucleation. However, malignant PNTs and premalignant cysts should be managed with either a Whipple resection or distal pancreatectomy, depending on the location of the tumor, with local lymph node resection [3] whenever indicated.…”