Insulinoma surgery: Difference between revisions

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Revision as of 03:31, 11 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]Parminder Dhingra, M.D. [3]

Overview

Surgery is the mainstay of treatment for insulinoma. The feasibility of surgery depends on the stage of insulinoma at diagnosis.^[1]^[2]

Surgery

Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. It can be 80-100% curative in experienced surgical hands.

Benign Tumors

Small well-encapsulated, solitary tumors:^[1]^[2]^[3]Tumors are localized with palpation in 70 % cases during surgery. Intraoperative ultrasound (IOUS) localizes in 86% of times. Palpation and IOUS together localize tumor in 83-98% cases.^[4]^[5]

Insulinoma. By Edward Alabraba et al. - Pancreatic insulinoma co-existing with gastric GIST in the absence of neurofibromatosis-1. World Journal of Surgical Oncology 2009, 7:18doi:10.1186/1477-7819-7-18, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=6686376

Surgical resection is the treatment of choice. Minimal invasive surgery such as laparoscopic surgery is preferred especially for small and solitary benign insulinomas.

Enucleation
Partial pancreatectomy
Distal pancreatectomy
Pancreaticoduodenectomy^[6]

Multiple, unencapsulated, >4 cm in diameter, and involves or is near the main pancreatic duct:

Radical resection

Insulinomas which are associated with MEN1, excision of tumor found in the head of the pancreas plus a distal subtotal pancreatectomy is recommended.^[7]
For occult insulinomas, blind distal pancreatectomy is not advisable.^[8]

Malignant Tumors

Resectable tumors:^[1]^[2]^[3]

Aggressive surgical resection, including extended pancreatic resection with lymph nodes, liver resection, and/or liver transplantation
Post-surgical chemoembolization or radiofrequency ablation of tumors to control hypoglycemia

Unresectable tumors

Octreotide administration
Continous glucose monitoring
Radiofrequency ablation
Embolization
Intra-arterial chemotherapy

Indications

Repeated and prolonged symptoms of hypoglycemia

References

↑ ^1.0 ^1.1 ^1.2 Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y; et al. (2013). "Diagnosis and management of insulinoma". World J Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.
↑ ^2.0 ^2.1 ^2.2 Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm
↑ ^3.0 ^3.1 Service FJ, McMahon MM, O'Brien PC, Ballard DJ (1991). "Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study". Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.
↑ Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P; et al. (1988). "Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation". Ann Surg. 207 (2): 160–8. PMC 1493387. PMID 2829761.
↑ Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR; et al. (2008). "Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital". Ann Surg. 247 (1): 165–72. doi:10.1097/SLA.0b013e31815792ed. PMC 3806046. PMID 18156937.
↑ Vázquez Quintana E (2004). "The surgical management of insulinoma". Bol Asoc Med P R. 96 (1): 33–8. PMID 15575328.
↑ Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH (1991). "Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach". Surgery. 110 (6): 998–1004, discussion 1004-5. PMID 1684067.
↑ Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A; et al. (2002). "Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure". J Am Coll Surg. 194 (6): 761–4. PMID 12081066.

Template:WikiDoc Sources

[pmid23430217-1] 1.0 ^1.1 ^1.2 Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y; et al. (2013). "Diagnosis and management of insulinoma". World J Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.

[surgery-2] 2.0 ^2.1 ^2.2 Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm

[pmid1677058-3] 3.0 ^3.1 Service FJ, McMahon MM, O'Brien PC, Ballard DJ (1991). "Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study". Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.

[pmid2829761-4] Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P; et al. (1988). "Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation". Ann Surg. 207 (2): 160–8. PMC 1493387. PMID 2829761.

[pmid18156937-5] Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR; et al. (2008). "Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital". Ann Surg. 247 (1): 165–72. doi:10.1097/SLA.0b013e31815792ed. PMC 3806046. PMID 18156937.

[pmid15575328-6] Vázquez Quintana E (2004). "The surgical management of insulinoma". Bol Asoc Med P R. 96 (1): 33–8. PMID 15575328.

[pmid1684067-7] Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH (1991). "Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach". Surgery. 110 (6): 998–1004, discussion 1004-5. PMID 1684067.

[pmid12081066-8] Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A; et al. (2002). "Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure". J Am Coll Surg. 194 (6): 761–4. PMID 12081066.

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@@ Line 6: / Line 6: @@
 ==Surgery==
-Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. It can be 100% curative in experienced surgical hands.
+Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. It can be 80-100% curative in experienced surgical hands.
 ===Benign Tumors===
-*Small well-encapsulated, solitary tumors:<ref name="pmid23430217">{{cite journal| author=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y et al.| title=Diagnosis and management of insulinoma. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 6 | pages= 829-37 | pmid=23430217 | doi=10.3748/wjg.v19.i6.829 | pmc=PMC3574879 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23430217  }} </ref><ref name="surgery">Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm</ref><ref name="pmid1677058">{{cite journal| author=Service FJ, McMahon MM, O'Brien PC, Ballard DJ| title=Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. | journal=Mayo Clin Proc | year= 1991 | volume= 66 | issue= 7 | pages= 711-9 | pmid=1677058 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1677058  }} </ref>Tumors is localised with palpation in 70 % cases during surgery. Intraoperative ultrasound(IOUS) localizes in 86% of times. Palpation and IOUS together localizes tumor in 83-98% cases.<ref name="pmid2829761">{{cite journal| author=Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P et al.| title=Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation. | journal=Ann Surg | year= 1988 | volume= 207 | issue= 2 | pages= 160-8 | pmid=2829761 | doi= | pmc=1493387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829761  }} </ref><ref name="pmid18156937">{{cite journal| author=Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR et al.| title=Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital. | journal=Ann Surg | year= 2008 | volume= 247 | issue= 1 | pages= 165-72 | pmid=18156937 | doi=10.1097/SLA.0b013e31815792ed | pmc=3806046 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18156937  }} </ref>
+*Small well-encapsulated, solitary tumors:<ref name="pmid23430217">{{cite journal| author=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y et al.| title=Diagnosis and management of insulinoma. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 6 | pages= 829-37 | pmid=23430217 | doi=10.3748/wjg.v19.i6.829 | pmc=PMC3574879 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23430217  }} </ref><ref name="surgery">Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm</ref><ref name="pmid1677058">{{cite journal| author=Service FJ, McMahon MM, O'Brien PC, Ballard DJ| title=Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. | journal=Mayo Clin Proc | year= 1991 | volume= 66 | issue= 7 | pages= 711-9 | pmid=1677058 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1677058  }} </ref>Tumors are localized with palpation in 70 % cases during surgery. Intraoperative ultrasound (IOUS) localizes in 86% of times. Palpation and IOUS together localize tumor in 83-98% cases.<ref name="pmid2829761">{{cite journal| author=Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P et al.| title=Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation. | journal=Ann Surg | year= 1988 | volume= 207 | issue= 2 | pages= 160-8 | pmid=2829761 | doi= | pmc=1493387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829761  }} </ref><ref name="pmid18156937">{{cite journal| author=Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR et al.| title=Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital. | journal=Ann Surg | year= 2008 | volume= 247 | issue= 1 | pages= 165-72 | pmid=18156937 | doi=10.1097/SLA.0b013e31815792ed | pmc=3806046 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18156937  }} </ref>
   [[Image:Insulinoma.jpg|thumb|center|250px|Insulinoma. By Edward Alabraba et al. - Pancreatic insulinoma co-existing with gastric GIST in the absence of neurofibromatosis-1. World Journal of Surgical Oncology 2009, 7:18doi:10.1186/1477-7819-7-18, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=6686376]]
 *Surgical resection is the treatment of choice. Minimal invasive surgery such as laparoscopic surgery is preferred especially for small and solitary benign insulinomas.