Surgical management of patients with insulinomas: Result of 292 cases in a single institution

Abstract

Surgery is the best treatment of choice for insulinoma patients. Surgical approach depends on tumor size, location, and its pathological characters. Laparoscopic management of insulinomas is feasible and safe for tumors located in the body or tail of the pancreas. Open surgery combined with intraoperative ultrasonography is recommended to avoid omission of lesions in patients with multiple insulinomas. An aggressive surgical approach is indicated for malignant insulinoma patients.

Diagnosis and Treatment of Insulinomas in the Adults

“…Long-term remission can be achieved by surgery in 95% of patients according to a recent study (Zhao et al 2011). Two different types of surgery can be performed : minimal resection i.e.…”

“…Providing that the tumour present with the above mentioned characteristics, and that surgery is performed by experienced surgeons, the risk of pancreatic fistula is not higher than that observed in larger resections of the pancreas (Kooby et al 2008). When tumour enucleation is not possible, central pancreatectomy for a tumour in the pancreatic neck or adjacent body is preferred by several groups (Muller et al 2006;Crippa et al 2007;Zhao et al 2011), in order to preserve a functional pancreatic gland, and to reduce the risks of post-operative pancreatic exocrine deficiency and diabetes mellitus (Crippa et al 2007;Hirono et al 2009). A larger pancreatic resection, i.e.…”

“…When enucleation is possible, or even when left-sided pancreatectomy is to be performed, laparoscopy is now employed (Crippa et al 2007). It reduces the duration of the stay in the hospital and improves the post-operative quality of life (Zhao et al 2011). It must be performed only by experienced surgeons.…”

“…Pancreatic fistulae are more frequent after enucleation or left-sided pancreatectomy, but their consequences are more severe after pancreaticoduodenectomy, due to infectious or haemorrhagic complications. They occur globally in 3-60% of cases, depending on the definition (Pannegeon et al 2006;Yoshioka et al 2010;Zhao et al 2011). Most of them are asymptomatic and no additional treatment is necessary.…”

“…Most of them are asymptomatic and no additional treatment is necessary. The clinical prevalence of pancreatic fistulae is about 14% (Zhao et al 2011). Other complications are intra-abdominal abscess (6.6%), pulmonary infections (3.7%), wound infection (2.5%), delayed gastric emptying (2.2%), abdominal bleeding (1.3%) acute pancreatitis (0.6%) and pulmonary embolism (0.6%) (Zhao et al 2011).…”