Insulinoma surgery

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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]

Surgery

The definitive management is surgical removal of the insulinoma. This may involve removing part of the pancreas as well (Whipple procedure and distal pancreatectomy).

Benign Tumors

• 90%
• Small well-encapsulated, solitary tumors:

• 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

• 10%
• Resectable 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