Glucagonoma surgery: Difference between revisions

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==Overview==
==Overview==
Surgery is the mainstay of treatment for glucagonoma. The feasibility of surgery depends on the stage of glucagonoma at diagnosis.<ref name="pmid15313692">{{cite journal| author=Zhang M, Xu X, Shen Y, Hu ZH, Wu LM, Zheng SS| title=Clinical experience in diagnosis and treatment of glucagonoma syndrome. | journal=Hepatobiliary Pancreat Dis Int | year= 2004 | volume= 3 | issue= 3 | pages= 473-5 | pmid=15313692 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15313692  }} </ref>
Surgery is the mainstay of treatment for glucagonoma. The feasibility of surgery depends on the stage of glucagonoma at diagnosis.


==Surgery==
==Surgery==
Surgery is the mainstay of treatment for glucagonoma. The feasibility of surgery depends on the stage of glucagonoma at diagnosis.<ref name="pmid15313692">{{cite journal| author=Zhang M, Xu X, Shen Y, Hu ZH, Wu LM, Zheng SS| title=Clinical experience in diagnosis and treatment of glucagonoma syndrome. | journal=Hepatobiliary Pancreat Dis Int | year= 2004 | volume= 3 | issue= 3 | pages= 473-5 | pmid=15313692 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15313692  }} </ref><ref>Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). National Cancer Institute. http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_88</ref>
 
=== Management of primary disease ===
* Surgery is the mainstay of treatment for glucagonoma.
* Resection of the primary pancreatic tumor is indicated if the tumor is resectable with a good general condition. It offers the chance of complete cure.<ref name="pmid8628004">{{cite journal| author=Smith AP, Doolas A, Staren ED| title=Rapid resolution of necrolytic migratory erythema after glucagonoma resection. | journal=J Surg Oncol | year= 1996 | volume= 61 | issue= 4 | pages= 306-9 | pmid=8628004 | doi=10.1002/(SICI)1096-9098(199604)61:4<306::AID-JSO15>3.0.CO;2-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8628004  }}</ref>
* Preoperative management
* Total parenteral nutrition may be required before the surgery. Infusions of amino and fatty acids reduce symptoms and improve survival rates.<ref name="pmid12460334">{{cite journal| author=Alexander EK, Robinson M, Staniec M, Dluhy RG| title=Peripheral amino acid and fatty acid infusion for the treatment of necrolytic migratory erythema in the glucagonoma syndrome. | journal=Clin Endocrinol (Oxf) | year= 2002 | volume= 57 | issue= 6 | pages= 827-31 | pmid=12460334 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12460334  }}</ref>
 
=== Management of metastasis ===
Hepatic resection is indicated for the treatment of metastatic liver disease in patients who are candidates for surgery with no extensive extrahepatic metastases. It may potentially increase survival and has the benefit of symptom palliation.<ref name="pmid1701060">{{cite journal| author=McEntee GP, Nagorney DM, Kvols LK, Moertel CG, Grant CS| title=Cytoreductive hepatic surgery for neuroendocrine tumors. | journal=Surgery | year= 1990 | volume= 108 | issue= 6 | pages= 1091-6 | pmid=1701060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1701060  }}</ref>
 
The feasibility of surgery depends on the stage of glucagonoma at diagnosis.<ref name="pmid15313692">{{cite journal| author=Zhang M, Xu X, Shen Y, Hu ZH, Wu LM, Zheng SS| title=Clinical experience in diagnosis and treatment of glucagonoma syndrome. | journal=Hepatobiliary Pancreat Dis Int | year= 2004 | volume= 3 | issue= 3 | pages= 473-5 | pmid=15313692 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15313692  }} </ref><ref>Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). National Cancer Institute. http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_88</ref>
*Single, small lesion in head or tail of [[pancreas]]:
*Single, small lesion in head or tail of [[pancreas]]:
:*Enucleation, if feasible
*Enucleation, if feasible
 
*Large lesion in the head of the pancreas that is not amenable to enucleation:
*Large lesion in the head of the pancreas that is not amenable to enucleation:
:*Pancreaticoduodenectomy
*Pancreaticoduodenectomy
 
*Single, large lesion in body/tail:
*Single, large lesion in body/tail:
:*Distal pancreatectomy
*Distal pancreatectomy
 
*Multiple lesions:
*Multiple lesions:
:*Enucleation, if feasible
*Enucleation, if feasible
:*Resect body and tail otherwise
*Resect body and tail otherwise
*Metastatic disease: [[lymph nodes]] or distant sites:
:*Resect when possible
:*Consider radiofrequency or cryosurgical ablation, if not resectable
*Unresectable disease:
:*Combination [[chemotherapy]]
:*[[Somatostatin]] analogue therapy. Necrotizing erythema of glucagonoma may be relieved in 24 hours with somatostatin analogue, with nearly complete disappearance within 1 week
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 18:52, 1 August 2017

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

Overview

Surgery is the mainstay of treatment for glucagonoma. The feasibility of surgery depends on the stage of glucagonoma at diagnosis.

Surgery

Management of primary disease

  • Surgery is the mainstay of treatment for glucagonoma.
  • Resection of the primary pancreatic tumor is indicated if the tumor is resectable with a good general condition. It offers the chance of complete cure.[1]
  • Preoperative management
  • Total parenteral nutrition may be required before the surgery. Infusions of amino and fatty acids reduce symptoms and improve survival rates.[2]

Management of metastasis

Hepatic resection is indicated for the treatment of metastatic liver disease in patients who are candidates for surgery with no extensive extrahepatic metastases. It may potentially increase survival and has the benefit of symptom palliation.[3]

The feasibility of surgery depends on the stage of glucagonoma at diagnosis.[4][5]

  • Single, small lesion in head or tail of pancreas:
  • Enucleation, if feasible
  • Large lesion in the head of the pancreas that is not amenable to enucleation:
  • Pancreaticoduodenectomy
  • Single, large lesion in body/tail:
  • Distal pancreatectomy
  • Multiple lesions:
  • Enucleation, if feasible
  • Resect body and tail otherwise

References

  1. ↑ Smith AP, Doolas A, Staren ED (1996). "Rapid resolution of necrolytic migratory erythema after glucagonoma resection". J Surg Oncol. 61 (4): 306–9. doi:10.1002/(SICI)1096-9098(199604)61:4<306::AID-JSO15>3.0.CO;2-3. PMID 8628004.
  2. ↑ Alexander EK, Robinson M, Staniec M, Dluhy RG (2002). "Peripheral amino acid and fatty acid infusion for the treatment of necrolytic migratory erythema in the glucagonoma syndrome". Clin Endocrinol (Oxf). 57 (6): 827–31. PMID 12460334.
  3. ↑ McEntee GP, Nagorney DM, Kvols LK, Moertel CG, Grant CS (1990). "Cytoreductive hepatic surgery for neuroendocrine tumors". Surgery. 108 (6): 1091–6. PMID 1701060.
  4. ↑ Zhang M, Xu X, Shen Y, Hu ZH, Wu LM, Zheng SS (2004). "Clinical experience in diagnosis and treatment of glucagonoma syndrome". Hepatobiliary Pancreat Dis Int. 3 (3): 473–5. PMID 15313692.
  5. ↑ Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). National Cancer Institute. http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_88


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