Localization and surgical management of insulinoma

Abstract

Over a 14-year period 34 patients were referred for surgical treatment of insulinoma. The diagnosis was confirmed by demonstrating hypoglycaemia with inappropriate hyperinsulinaemia during prolonged fasting. Selective visceral angiography localized 30 solitary benign insulinomas and two carcinomas. In two patients with islet cell hyperplasia, angiography demonstrated a single lesion only. Ultrasonography had a sensitivity of 15 per cent and computed tomography a sensitivity of 24 per cent in the localization of tumours. All patients but one were treated by operation. Eighteen tumours were enucleated and 13 (including both patients with islet cell hyperplasia) were treated by distal pancreatectomy. Two patients underwent negative primary exploration; both had single adenomas removed at re-exploration. There were no operative deaths but nine patients (predominantly those undergoing pancreatic resection) had complications. Thirty-one patients were symptom-free following operation at a mean follow-up of 16 months.

Accurate Preoperative Localization of Insulinomas Avoids the Need for Blind Resection and Reoperation: Analysis of a Single Institution Experience with 17 Surgically Treated Tumors over 19 Years

“…The mortality occurred in a patient who developed postoperative deep vein thrombosis complicated by fatal pulmonary embolism. Overall, there were six pancreatic fistulas (35%) according to the ISGPF definition, of which five were grade A and one was grade C. The median postoperative stay was 9 (range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] days.…”

Anatomical localization of insulinomas: still a need to combine a set of diagnostic procedures

“…5, 7 An integrated pre-operative and intra-operative diagnostic study for tumor localization was properly done and finally allowed the anatomical definition of the lesion in both cases, as required for the most appropriate, safe, and effective surgical approach. [9][10][11] The histological examination of the surgical specimens showed definite neuroendocrine features that were compatible with the diagnosis of insulinoma in both patients when combined with the clinical manifestations and the biochemical data. One of the two insulinomas was negative for insulin immunostaining, an occasional finding in these lesions, which may result from a rapid release of insulin by tumor insulin-secreting cells with a failure to store.…”

Insulinoma – Diagnosis and Treatment

“…Both types of operations may be subsequently associated with complications. Following resection, subfrenic inflammation causing localized abscess, sepsis or fistulae may be developed (Geoghegan et al, 1994). Fistulae develop sometimes after enucleation as well (Pasieka et al, 1992).…”