Pancreatic insulinomas: Laparoscopic management

Abstract

Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple's triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, β-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available.

Minimally invasive versus open pancreatic enucleation. Systematic review and meta‐analysis of surgical outcomes

“…On the basis of titles and abstracts, a total of 39 potentially pertinent records were detected. Nine additional records were identified by hand searching of bibliographies, for a total of 48 records . After the evaluation of full‐texts, eight studies met all the inclusion criteria and were considered eligible for data extraction and meta‐analysis.…”

“…After the evaluation of full‐texts, eight studies met all the inclusion criteria and were considered eligible for data extraction and meta‐analysis. The remaining studies were excluded for the following reasons: impossibility to extrapolate detailed data of MIS versus open surgery: 14 studies, absence of a comparator group: 18 studies, reviews articles: 7 studies and presence of duplicate data: 1 study . The selection process is described in Figure , while Table depicts the general characteristics of the included studies.…”

Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches

“…Recent studies indicate superior short-term recovery and equivalent long-term outcomes after minimally-invasive pancreatic resection compared to open pancreatic surgery [33–35]. Localization during minimally-invasive resection is critical to successful tumor clearance as the homogeneity of the retroperitoneal fat and decreased tactile feedback pose a challenge to intraoperative identification of lesions located deep in the pancreatic parenchyma.…”

“…Retrospective comparisons of minimally invasive and open surgery have shown similar successful tumor resection rates (>95%), operative times, complication and fistula rates, but minimally invasive approaches are associated with shorter lengths of stay [33], decreased blood loss and transfusion rates, and improved cosmesis [35]. Conversion rates with laparoscopic surgery approach 30%, often due to inability to locate the tumor when laparoscopic ultrasonography is not performed [37].…”

Treatment of insulinomas by laparoscopic radiofrequency ablation: case reports and literature review

“…Anatomical distribution may vary throughout any part of the pancreas, but they are predominantly located in the pancreatic body and tail [2]. Surgical resection or enucleation is the first line of curative treatment choice for insulinoma [3,4]. The adoption of surgical procedures required are dependent on the anatomical position and size of the tumor.…”