Pancreatic insulinomas

Abstract

We report a series of 30 patients with pancreatic insulinoma treated from 1967 to 1990. Twenty-nine patients underwent surgery. In 24 patients, the lesion was a benign adenoma. The pancreatic lesion was localized preoperatively in 59% of cases (94% since 1980), and all lesions that were identifiable histologically were palpable intraoperatively. Endoscopic pancreatic ultrasonography, performed twice, appeared to be a very promising method of investigation. In the 24 patients with adenoma, 14 enucleations and 10 pancreatic resections were performed, with the enucleation rate increasing over time. One patient died during the postoperative period. Pancreatic fistulas (43%) were the most common cause of morbidity and were more common after enucleation (57% versus 29% after pancreatectomy). The mean follow-up period was 7 years. Excluding the patients with adenocarcinomas, the recovery rate was 92% (23 of 25 among whom 2 patients had transitory recurrent hypoglycemia), 2 patients who underwent corporeo-caudal pancreatectomy being diabetic (8%).

Improved Contemporary Surgical Management of Insulinomas

“…Nonetheless, pancreatic fistulas were detected in 5 of 21 (24%) patients after enucleation, 4 of which had minimal clinical impact (Grade A). This compares favorably to other series that report pancreatic fistula rates as high as 57% after enucleation 3,32 Of note, 7 of 21 (33%) patients treated by enucleation had positive margins on histology. None had recurrence at the site of enucleation on long-term follow-up.…”

Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema

“…Doherty et al (27) have identified 64% of insulinomas by means of palpation. Machado et al (16) have reported the detection of 98.2% of cases by means of inspection/palpation, a result similar to those of other authors (35)(36)(37) . The literature review demonstrates that smaller the lesions to be evaluated, the greater will be the limitations of preoperative examinations.…”

Localization of Insulinomas

“…1 Other localization studies have been used, including preoperative ultrasonography, transgastric endoscopy, computed tomography (CT), magnetic resonance (MR) imaging, radionuclide scanning, transhepatic venous catheterization, and calciumstimulated angiography with catheterization of hepatic veins. [2][3][4][5] Despite the many attempts aimed at localizing insulinomas, the tumors remain undetected in about 40% of patients. 6 The purpose of this study was to review the results of the localization techniques in 66 consecutive patients who were surgically treated for insulinomas at University of California, San Francisco, from 1975 to 1998.…”