Insulinoma surgery: Difference between revisions

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__NOTOC__
__NOTOC__
{{Insulinoma}}
{{Insulinoma}}
{{CMG}}{{AE}}{{PSD}}
{{CMG}}{{AE}}{{ADS}}{{PSD}}
==Overview==
==Overview==
Surgery is the mainstay of treatment for insulinoma. The feasibility of surgery depends on the stage of insulinoma at diagnosis.<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>
Surgery is the mainstay of treatment for insulinoma. The feasibility of surgery depends on the stage of insulinoma at diagnosis.<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>
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Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. The feasibility of surgery depends on the stage of insulinoma at diagnosis.
Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. The feasibility of surgery depends on the stage of insulinoma at diagnosis.
===Benign Tumors===
===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>
*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>
:*Surgical resection is treatment of choice (minimal invasive surgery)
:*Surgical resection is treatment of choice (minimal invasive surgery)
::*Enucleation
::*Enucleation
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===Malignant Tumors===
===Malignant Tumors===
*Resectable 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>
*Resectable 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>
:*Aggressive surgical resection, including extended pancreatic resection, [[liver resection]], and/or [[liver transplantation]]
:*Aggressive surgical resection, including extended pancreatic resection, [[liver resection]], and/or [[liver transplantation]]
:*Post-surgical chemoembolization or radiofrequency ablation of tumors to control hypoglycemia
:*Post-surgical chemoembolization or radiofrequency ablation of tumors to control hypoglycemia
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:*[[Embolization]]
:*[[Embolization]]
:*Intra-arterial chemotherapy
:*Intra-arterial chemotherapy
==Overview==
Surgery is the mainstay of treatment for insulinoma
==Surgery==
*Surgical intervention is not recommended for the management of [disease name].
OR
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
*Surgery is the mainstay of treatment for [disease or malignancy].


==Indications==
==Indications==
 
* Repeated and prolonged symptoms of hypoglycemia


==References==
==References==

Revision as of 16:09, 7 September 2017

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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. The feasibility of surgery depends on the stage of insulinoma at diagnosis.

Benign Tumors

  • Small well-encapsulated, solitary tumors:[1][2][3]
  • Surgical resection is treatment of choice (minimal invasive surgery)
  • Enucleation
  • Partial pancreatectomy
  • Middle pancreatectomy
  • Multiple, unencapsulated, >4 cm in diameter, and involves or is near the main pancreatic duct:
  • Radical resection

Malignant Tumors

  • Aggressive surgical resection, including extended pancreatic resection, liver resection, and/or liver transplantation
  • Post-surgical chemoembolization or radiofrequency ablation of tumors to control hypoglycemia
  • Unresectable tumors
  • Octreotide administration
  • Continous glucose monitoring
  • Radiofrequecy ablation
  • Embolization
  • Intra-arterial chemotherapy

Indications

  • Repeated and prolonged symptoms of hypoglycemia

References

  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.
  2. ↑ 2.0 2.1 2.2 Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm
  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.



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