Insulinoma surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Insulinoma}} | {{Insulinoma}} | ||
{{CMG}}{{AE}}{{ADS}}{{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> | ||
==Surgery== | ==Surgery== | ||
Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. It can be 80-100% 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=== | ===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 are localized with palpation in 70 % cases during surgery. Intra-operative 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]] | [[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. | *[[Surgical resection]] is the treatment of choice. Minimal invasive surgery such as [[laparoscopic surgery]] is preferred especially for small and [[solitary]] [[benign]] insulinomas. | ||
:*Enucleation | :*[[Enucleation]] | ||
:*Partial pancreatectomy | :*Partial [[pancreatectomy]] | ||
:*Distal pancreatectomy | :*Distal [[pancreatectomy]] | ||
:*Pancreaticoduodenectomy<ref name="pmid15575328">{{cite journal| author=Vázquez Quintana E| title=The surgical management of insulinoma. | journal=Bol Asoc Med P R | year= 2004 | volume= 96 | issue= 1 | pages= 33-8 | pmid=15575328 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15575328 }} </ref> | :*[[Pancreaticoduodenectomy]]<ref name="pmid15575328">{{cite journal| author=Vázquez Quintana E| title=The surgical management of insulinoma. | journal=Bol Asoc Med P R | year= 2004 | volume= 96 | issue= 1 | pages= 33-8 | pmid=15575328 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15575328 }} </ref> | ||
*Multiple, unencapsulated, >4 cm in diameter, and involves or is near the main pancreatic duct: | *Multiple, unencapsulated, > 4 cm in diameter, and involves or is near the main pancreatic duct: | ||
:*Radical resection | :*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.<ref name="pmid1684067">{{cite journal| author=Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH| title=Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach. | journal=Surgery | year= 1991 | volume= 110 | issue= 6 | pages= 998-1004; discussion 1004-5 | pmid=1684067 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1684067 }} </ref> | *Insulinomas which are associated with [[MEN1]], excision of tumor found in the head of the [[pancreas]] plus a distal subtotal [[pancreatectomy]] is recommended.<ref name="pmid1684067">{{cite journal| author=Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH| title=Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach. | journal=Surgery | year= 1991 | volume= 110 | issue= 6 | pages= 998-1004; discussion 1004-5 | pmid=1684067 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1684067 }} </ref> | ||
*For occult insulinomas, blind distal pancreatectomy is not advisable.<ref name="pmid12081066">{{cite journal| author=Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A et al.| title=Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. | journal=J Am Coll Surg | year= 2002 | volume= 194 | issue= 6 | pages= 761-4 | pmid=12081066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12081066 }} </ref> | *For occult insulinomas, blind distal [[pancreatectomy]] is not advisable. <ref name="pmid12081066">{{cite journal| author=Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A et al.| title=Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. | journal=J Am Coll Surg | year= 2002 | volume= 194 | issue= 6 | pages= 761-4 | pmid=12081066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12081066 }} </ref> | ||
===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><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> | *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 with lymph nodes, [[liver resection]], and/or [[liver transplantation]] | :*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 | :*Post-surgical [[chemoembolization]] or [[radiofrequency ablation]] of [[tumors]] to control [[hypoglycemia]]. | ||
*Unresectable tumors | *Unresectable tumors | ||
:*[[Octreotide]] administration | :*[[Octreotide]] administration | ||
:* | :*Continuous [[glucose]] monitoring | ||
:*[[Radiofrequency ablation]] | :*[[Radiofrequency ablation]] | ||
:*[[Embolization]] | :*[[Embolization]] | ||
Revision as of 16:40, 22 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. 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. Intra-operative ultrasound (IOUS) localizes in 86% of times. Palpation and IOUS together localize tumor in 83-98% cases.[4][5]
- 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
- 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
- Continuous 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.