Insulinoma surgery: Difference between revisions
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===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><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 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> | ||
*Surgical resection is treatment of choice. Minimal invasive surgery such as laparscopic surgery is preferred especially for small and solitary benign insulinomas. | |||
::*Enucleation | ::*Enucleation | ||
::*Partial pancreatectomy | ::*Partial pancreatectomy | ||
Revision as of 16:23, 7 September 2017
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Insulinoma Microchapters |
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Insulinoma surgery On the Web |
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American Roentgen Ray Society Images of Insulinoma surgery |
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 100% curative in experienced surgical hands.
Benign Tumors
- Small well-encapsulated, solitary tumors:[1][2][3]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.[4][5]
- Surgical resection is treatment of choice. Minimal invasive surgery such as laparscopic surgery is preferred especially for small and solitary benign insulinomas.
- 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 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
- Radiofrequecy 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.