Insulinoma surgery
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Insulinoma Microchapters |
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Insulinoma surgery On the Web |
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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 to 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.