Management of Insulinomas: Analysis from a Tertiary Care Referral Center in India

Abstract

The aim of this study was to describe the localization and management of patients with pancreatic insulinomas and determine the most effective localization and surgical techniques in the presence of significant financial constraints in the patient population. We retrospectively reviewed the case records of 18 patients with insulinomas treated at our institution over a period of 10 years. The medical records were reviewed for demographic data, clinical presentation, biochemistry, details of localization studies, intraoperative findings, postoperative outcome, and long-term follow-up. The sensitivities of the various localization procedures were calculated using the intraoperative findings as the gold standard. There were 10 men and 8 women in the study, with a median age of 43 years. All patients underwent a supervised 72-hour fast and developed symptomatic hypoglycemia within 48 hours. An average of 1.9 localization procedures was performed per patient. Computed tomography (CT) had a sensitivity of 62% and specificity of 100%. Magnetic resonance imaging and digital subtraction angiography had specificities of 85% and 100%, respectively, with a specificity of 66% and 50%, respectively. Fourteen patients underwent surgery. Intraoperatively the excised tumor was palpable in nine patients, and all patients had postoperative euglycemia. In five patients the tumor was not palpable during the time of surgery; three of these patients underwent blind distal pancreactomy, with two patients having persistent hypoglycemia during the postoperative period. Two patients had a negative exploratory laparotomy. Patients with a surgical cure were followed up for a mean period of 24 months. On the background of financial constraints in connection with patient care, CT scanning is a cost-effective option with good specificity. Intraoperative palpation of the tumor and enucleation is the most effective technique for surgical cure. Blind distal pancreactomy is not advocated for tumors that are not localized intraoperatively.

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.…”

First experience of ultrasound-assisted percutaneous microwave ablation of insulin-producing pancreatic tumor

“…Все перечисленные симптомы в различных комбинациях встречают-ся у больных с частотой от 25 до 90%. Вначале они имеют интер-миттирующий характер, но с течением времени гипогликемиче-ские состояния становятся ежедневными и промежутки между приемами пищи или парентеральным введением глюкозы сокра-щаются до 2-3 ч. Таким образом, заболевание, протекающее 3-5 лет, приводит к тяжелым и часто необратимым изменениям в организме человека, являясь причиной выраженной энцефало-патии и нетрудоспособности [2,8,12,15,16].…”

“…Этого можно добиться единственно радикальным методом лечения органического гиперинсулинизма -хирургическим [4,7,11,12,[14][15][16]. Вместе с тем существуют причины и состояния, при которых оперативное лечение не показано или сопряжено с высоким риском для жизни пациента.…”

“…-создание большей, чем при РЧА, температуры в опухоле-вом очаге (выше 100 °С), при этом длительность воздействия меньше, а глубина проникновения больше; -отсутствие прямого электрического контакта с биологи-ческой тканью; -возможность нагрева сухих тканей (обезвоженных) и коа-гуляции сосудов [3,7,8,16].…”

Neuroendokrine Neoplasien des gastroenteropankreatischen Systems

“…95 % der Fälle handelt es sich um 1-2 cm große gut differenzierte Neoplasien, welche hinsichtlich ihres Wachstumsverhaltens in 90 % der Fälle als benigne eingestuft werden. Insbesondere bei den MEN-1 treten sie mit 10-20 % gehäuft multifokal im Sinne unabhängig voneinander entstandener Tumoren auf [26]. Differentialdiagnostisch sind sie von einer diffusen Betazellhyperplasie (Non-Insulinoma pankreatogenes Hypoglykämie-Syndrom (NIPHS)) oder auch der sehr seltenen Insulinomatose abzugrenzen [27,28].…”